NPIMap

Organization Active NPI

Longevity Management Group, LLC

  • Specialist
  • Apple Valley, CA
National Provider Identifier
1922438886
Registry record updated Nov 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PT 26869 Issued in CA
Legal business name
LONGEVITY MANAGEMENT GROUP, LLC
Practice address
15982 Quantico Rd
Suite D
Apple Valley, CA 92307-1382
Phone
(760) 242-8900
NPI assigned
Nov 13, 2013
Last updated
Nov 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2013

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

Authorized official

Name
Ms. Christina Brodbeck, PHYSICAL THERAPIST
Title
Director
Phone
(760) 242-8900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X PT 26869 CA Primary

Addresses

Primary practice location

15982 Quantico Rd
Suite D
Apple Valley, CA 92307-1382

Mailing address

15982 Quantico Rd
Suite D
Apple Valley, CA 92307-1382
Phone (760) 242-8900

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1922438886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15982 QUANTICO RD",
            "address_2": "SUITE D",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071382",
            "telephone_number": "760-242-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15982 QUANTICO RD",
            "address_2": "SUITE D",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923071382",
            "telephone_number": "760-242-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY MANAGEMENT GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-13",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "BRODBECK",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "760-242-8900",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT 26869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.