Kyle Pham, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT301453 Issued in CA

Practice address

9563 Laguna Springs Dr Ste 200
Elk Grove, CA 95758-8205

Phone

(916) 691-9822

NPI assigned

Dec 10, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stac Physical Therapy Laguna IncGroup PAC ID 7416384391, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kyle@laguna-pt.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stac Physical Therapy Laguna, Inc

  dba Laguna Physical Therapy and Hand Rehabilitation

  • Physical Therapist
  • Elk Grove, CA
  • NPI 1639713340
  Medicare reassignment Care Compare group
• Laguna Physical Therapy & Hand Rehabilitation

  • Physical Therapist
  • Elk Grove, CA
  • NPI 1912043993
  NPD

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

{
    "created_epoch": "1639094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1972262558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9563 LAGUNA SPRINGS DR STE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9563 LAGUNA SPRINGS DR STE 200",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957588205",
            "telephone_number": "916-691-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "KYLE",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-10",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT301453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kyle@laguna-pt.com",
            "affiliation": "N",
            "endpointDescription": "Work email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "9563 Laguna Springs Dr Ste 200",
            "city": "Elk Grove",
            "state": "CA",
            "country_code": "US",
            "postal_code": "957588205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Allison Petty
• Anh Ngoc Pham
• Elizabeth Pham
• James Pham
• Julie Thao Thanh Pham, DO
• Mia Thao Pham
• Nha Pham
• Phuong Pham
• Trang Pham, DMD
• Trung Tan Pham

• Physical Therapist in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; 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.