NPIMap

Organization Active NPI

Ida L Coryell Hirst

  • Physical Therapist
  • Pleasanton, CA
National Provider Identifier
1861494031
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT13904 Issued in CA
Legal business name
IDA L CORYELL HIRST
Practice address
3908 Valley Ave
Ste B
Pleasanton, CA 94566-4872
Phone
(925) 417-8005
Fax
(925) 417-8881
NPI assigned
Jun 1, 2005
Last updated
Nov 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ida L Coryell Hirst, PTNPI 1194876839
Title
Physical Therapist/Owner
Phone
(925) 417-8005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT13904 CA Primary

Addresses

Primary practice location

3908 Valley Ave
Ste B
Pleasanton, CA 94566-4872

Mailing address

3908 Valley Ave
Ste B
Pleasanton, CA 94566-4872
Phone (925) 417-8005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040903000606 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5890761514 Receives reassigned benefits from 9 practitioners
Practice locations: Pleasanton, CA

National Provider Directory

National Provider Directory

Locations

3908 Valley Ave
Pleasanton, CA 94566

3908 Valley Ave
Ste B
Pleasanton, CA 94566
Phone (925) 417-8005

2276 Camino Ramon
San Ramon, CA 94583
Phone (925) 417-8005

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1861494031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 VALLEY AVE",
            "address_2": "STE B",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945664872",
            "telephone_number": "925-417-8005",
            "fax_number": "925-417-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 VALLEY AVE",
            "address_2": "STE B",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945664872",
            "telephone_number": "925-417-8005",
            "fax_number": "925-417-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDA L CORYELL HIRST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "CORYELL HIRST",
        "authorized_official_first_name": "IDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "925-417-8005",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT13904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasanton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.