Individual provider Active NPI

Cristina Bracamonte, DPT

  • Orthopedic Physical Therapist
  • Cupertino, CA
National Provider Identifier
1891023479
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
36369 Issued in CA
Practice address
20823 Stevens Creek Blvd Ste 200
Cupertino, CA 95014-2112
Phone
(408) 252-6076
Fax
(408) 525-1159
NPI assigned
Nov 19, 2009
Last updated
Sep 16, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 9483 AZ
Physical Therapist 225100000X 9483PT AZ
Orthopedic Physical Therapist 2251X0800X 36369 CA Primary

Addresses

Primary practice location

20823 Stevens Creek Blvd Ste 200
Cupertino, CA 95014-2112

Mailing address

20823 Stevens Creek Blvd Ste 200
Cupertino, CA 95014-2112
Phone (408) 252-6076

Other practice location 1

68 Willow Rd
Menlo Park, CA 94025-3653
Phone (866) 839-6979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100504000187 CA Practitioner - Physical Therapist in Private Practice 0840328332 Reassigns benefits to 1 organization
I20111219000117 AZ Practitioner - Physical Therapist in Private Practice 0840328332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36369CAMDLicensed Psychiatric Technician
9483AZMDPhysical Therapist
9483PTAZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Foothills Sports Medicine & Rehabilitation- Tucson, LLC Physical Therapist CurrentSince Oct 16, 2017 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Sep 16, 2019 Accepting new patients

Locations

15410 S Mountain Pkwy
Ste 112
Phoenix, AZ 85044
Phone (480) 609-0822

7575 W Twin Peaks Rd
Ste 155
Tucson, AZ 85743
Phone (520) 290-1665

68 Willow Rd
Menlo Park, CA 94025
Phone (650) 691-8630

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1258588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1891023479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20823 STEVENS CREEK BLVD STE 200",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950142112",
            "telephone_number": "408-252-6076",
            "fax_number": "408-525-1159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20823 STEVENS CREEK BLVD STE 200",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950142112",
            "telephone_number": "408-252-6076",
            "fax_number": "408-525-1159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "68 Willow Rd",
            "address_purpose": "LOCATION",
            "city": "Menlo Park",
            "state": "CA",
            "postal_code": "940253653",
            "country_code": "US",
            "telephone_number": "866-839-6979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACAMONTE",
        "first_name": "CRISTINA",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-19",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9483",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9483PT",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "36369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cupertino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; 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.