NPIMap

Organization Active NPI

Restorative Therapy Associates

  • Physical Therapist
  • Irvine, CA
National Provider Identifier
1902102023
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
33693 Issued in CA
Legal business name
RESTORATIVE THERAPY ASSOCIATES
Practice address
15775 Laguna Canyon Rd Ste 110
Irvine, CA 92618-3192
Phone
(714) 858-4617
NPI assigned
Feb 8, 2011
Last updated
Feb 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Authorized official

Name
Derek DeciccoNPI 1427283894
Title
Partner/Physical Therapist
Phone
(714) 858-4617

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 33693 CA Primary

Addresses

Primary practice location

15775 Laguna Canyon Rd Ste 110
Irvine, CA 92618-3192

Mailing address

1154 Mission Dr
Costa Mesa, CA 92626-4209

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110812000573 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3072782705 Receives reassigned benefits from 12 practitioners
Practice locations: Irvine, CA; Laguna Hills, CA

National Provider Directory

National Provider Directory
Tax ID family
MVP Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

101 Pacifica
Ste 270
Irvine, CA 92618
Phone (949) 333-3833

23521 Paseo de Valencia
Ste 110
Laguna Hills, CA 92653
Phone (949) 333-3833

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424908800000",
    "number": "1902102023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1154 MISSION DR",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15775 LAGUNA CANYON RD STE 110",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183192",
            "telephone_number": "714-858-4617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORATIVE THERAPY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-08",
        "last_updated": "2015-02-26",
        "status": "A",
        "authorized_official_last_name": "DECICCO",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "PARTNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "714-858-4617"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "33693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.