Individual provider Active NPI

Gary Anthony Coleman, PT

  • Physical Therapist
  • Menifee, CA
National Provider Identifier
1932184702
Registry record updated Nov 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT14720 Issued in CA
Practice address
29650 Bradley Rd
Menifee, CA 92586-6521
Phone
(951) 672-0455
Fax
(951) 672-0206
NPI assigned
Dec 14, 2005
Last updated
Nov 2, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT14720 CA Primary

Addresses

Primary practice location

29650 Bradley Rd
Menifee, CA 92586-6521

Mailing address

29650 Bradley Rd
Menifee, CA 92586-6521
Phone (951) 672-0455

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090827000697 CA Practitioner - Physical Therapist in Private Practice 5890840763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Walker Physical Therapy, IncGroup PAC ID 3072697879, 12 clinicians

Practice addresses (Care Compare)

29650 Bradley Rd
Menifee, CA 92586-6521
Phone (951) 672-0455

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT14720CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Walker Physical Therapy, Inc Physical Therapist CurrentSince Sep 23, 2004 Accepting new patients

Locations

29650 Bradley Rd
Sun City, CA 92586
Phone (951) 672-0455

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288656000000",
    "number": "1932184702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29650 BRADLEY RD",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925866521",
            "telephone_number": "951-672-0455",
            "fax_number": "951-672-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29650 BRADLEY RD",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925866521",
            "telephone_number": "951-672-0455",
            "fax_number": "951-672-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "GARY",
        "middle_name": "ANTHONY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2010-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT14720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menifee, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.