Organization Active NPI

Lincoln Physical and Occupational Therapy, Inc

  • Orthopedic Physical Therapist
  • Lincoln, CA
National Provider Identifier
1912066705
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT 14005 Issued in CA
Legal business name
LINCOLN PHYSICAL AND OCCUPATIONAL THERAPY, INC
Practice address
150 Gateway Dr Ste a
Lincoln, CA 95648-3316
Phone
(916) 434-9572
Fax
(916) 434-9063
NPI assigned
Dec 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Authorized official

Name
Mary Dewitt, OTNPI 1255410767
Title
Ceo
Phone
(916) 434-9572

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X PT 14005 CA Primary

Addresses

Primary practice location

150 Gateway Dr Ste a
Lincoln, CA 95648-3316

Mailing address

150 Gateway Dr Ste a
Lincoln, CA 95648-3316
Phone (916) 434-9572

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071026000164 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5799872537 Receives reassigned benefits from 4 practitioners
Practice locations: Lincoln, CA

National Provider Directory

National Provider Directory

Locations

150 Gateway Dr
Ste A
Lincoln, CA 95648
Phone (916) 434-9572

1530 3rd St
Ste 211
Lincoln, CA 95648
Phone (916) 434-9572

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1912066705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 GATEWAY DR STE A",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956483316",
            "telephone_number": "916-434-9572",
            "fax_number": "916-434-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 GATEWAY DR STE A",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956483316",
            "telephone_number": "916-434-9572",
            "fax_number": "916-434-9063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN PHYSICAL AND OCCUPATIONAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-07",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "DEWITT",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-434-9572",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT 14005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.