Active NPI
Mitchell Tsurudome, DPT
- Physical Therapist
- Gardena, CA
National Provider Identifier
1902054737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 26175
- Practice address
- 16420 S Harvard Blvd
Unit 1
Gardena, CA 90247-4773 - Phone
- (310) 538-4725
- NPI assigned
- Sep 5, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 26175 | CA | Primary |
Addresses
Primary practice location
16420 S Harvard Blvd
Unit 1
Gardena, CA 90247-4773
Mailing address
16420 S Harvard Blvd
Unit 1
Gardena, CA 90247-4773
Phone (310) 538-4725
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26175 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Balance Rehabilitation, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Lake Forest, CA
- NPI 1184734931
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220572800000",
"number": "1902054737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16420 S HARVARD BLVD",
"address_2": "UNIT 1",
"city": "GARDENA",
"state": "CA",
"postal_code": "902474773",
"telephone_number": "310-538-4725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16420 S HARVARD BLVD",
"address_2": "UNIT 1",
"city": "GARDENA",
"state": "CA",
"postal_code": "902474773",
"telephone_number": "310-538-4725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TSURUDOME",
"first_name": "MITCHELL",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-05",
"last_updated": "2008-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "26175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gardena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.