NPIMap

Organization Active NPI

Active Physical Therapy, Inc

  • Orthopedic Physical Therapist
  • Santa Maria, CA
National Provider Identifier
1902978968
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT 21537 Issued in CA
Legal business name
ACTIVE PHYSICAL THERAPY, INC
Practice address
1105 E Foster Rd Ste B
Santa Maria, CA 93455-6400
Phone
(805) 934-0663
NPI assigned
Nov 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jordan Albright Larson, P.T., O.C.S.NPI 1740352392
Title
Vice President
Phone
(805) 934-0663

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
Orthopedic Physical Therapist 2251X0800X PT 21537 CA Primary

Addresses

Primary practice location

1105 E Foster Rd Ste B
Santa Maria, CA 93455-6400

Mailing address

247 Santa Fe Ave
Pismo Beach, CA 93449-1948

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041207001234 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6406812817 Receives reassigned benefits from 6 practitioners
Practice locations: Santa Maria, CA

National Provider Directory

National Provider Directory
Tax ID family
Active 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

1105 E Foster Rd
Ste B
Santa Maria, CA 93455
Phone (805) 934-0663

5075 S Bradley Rd
Ste 121
Santa Maria, CA 93455
Phone (805) 878-7743

Practitioners & affiliated clinicians

Practitioners 9

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902978968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 SANTA FE AVE",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934491948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E FOSTER RD STE B",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934556400",
            "telephone_number": "805-934-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "ALBRIGHT",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "805-934-0663",
        "authorized_official_credential": "P.T., O.C.S."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT 21537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.