NPIMap

Organization Active NPI

Five Star Physical Therapy, Inc.

Doing business as PT 360

  • Physical Therapist
  • Covina, CA
National Provider Identifier
1861855934
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT25293 Issued in CA
Legal business name
FIVE STAR PHYSICAL THERAPY, INC.
Doing business as
PT 360
Practice address
234 N Citrus Ave
Covina, CA 91723-2003
Phone
(626) 331-0077
Fax
(626) 331-0067
NPI assigned
Apr 5, 2016
Last updated
Aug 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
Sean Callahan, PTNPI 1639191901
Title
Owner
Phone
(626) 331-0077

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 Therapist 225100000X PT25293 CA Primary

Addresses

Primary practice location

234 N Citrus Ave
Covina, CA 91723-2003

Mailing address

234 N Citrus Ave
Covina, CA 91723-2003
Phone (626) 331-0077

Other names 1

  • PT 360 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170125000736 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2062794126 Receives reassigned benefits from 3 practitioners
Practice locations: Covina, CA

National Provider Directory

National Provider Directory

Locations

234 N Citrus Ave
Covina, CA 91723
Phone (626) 331-0077

234 N Citrus Ave
#360
Covina, CA 91723
Phone (626) 331-0077

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1861855934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 N CITRUS AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232003",
            "telephone_number": "626-331-0077",
            "fax_number": "626-331-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 N CITRUS AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232003",
            "telephone_number": "626-331-0077",
            "fax_number": "626-331-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "CALLAHAN",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-331-0077",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT25293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PT 360",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.