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Primary specialty

Physical TherapistTaxonomy code 225100000X

License

309240 Issued in CA

Practice address

801 Via Suerte Ste 103
San Clemente, CA 92673-6527

Phone

(949) 485-5567

NPI assigned

Nov 12, 2025

Last updated

Nov 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prosport Physical Therapy Professionals IncGroup PAC ID 0749510634, 93 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prosport Physical Therapy Professionals Inc

  • Physical Therapy Clinic/Center
  • Costa Mesa, CA
  • NPI 1073170437

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Prosport Physical Therapy Professionals Inc

  dba Palos Verdes Physical Therapy

  • Physical Therapist
  • Rancho Palos Verdes, CA
  • NPI 1487648341
  NPD

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

{
    "created_epoch": "1762905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1881554954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 VIA SUERTE STE 103",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736527",
            "telephone_number": "949-485-5567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 VIA SUERTE STE 103",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736527",
            "telephone_number": "949-485-5567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGE",
        "first_name": "SYDNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-12",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "309240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Liddell, BCBA
• Mi-Jin Lim, O.D.
• Tracy Rose Cynthia Lisauskas, LMFT, MA
• Sarah Kristine Little, PTA
• Colby Margaux Livingston, D.D.S.
• Lisa Beth Lombardi, FNP, RN, BSN, BA, LE
• Linda Marie Long, FNP-BC
• Francesca Longobardo, PA-C
• Alicia Lopez
• Ethan Timothy Lopez, DC

• Physical Therapist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.