Michael J Abughazaleh
Individual provider Active NPI Physical Therapist · Roseville, CA
NPI 1982113502 · NPPES record last updated Mar 28, 2022
Key facts
- NPI
- 1982113502
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 293784 (CA)
- Practice address
- 1600 Eureka Rd
Roseville, CA 95661-3027 - Phone
- (916) 784-4000
- NPI assigned
- Sep 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180619002993 | CA | Practitioner - Physical Therapist in Private Practice | 5597010397 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group Inc | Single Specialty | Current |
Accepting new patients |
Locations
750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
1600 Eureka Rd
Roseville, CA 95661
Phone (916) 474-7777
501 J St
Sacramento, CA 95814
Phone (916) 497-3000
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 293784 | CA | Yes |
Addresses
Primary practice location
1600 Eureka Rd
Roseville, CA 95661-3027
Mailing address
1224 Manza Cir
Roseville, CA 95678-5874
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21565 | Other | MA | MASSACHUSETTS PT LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Roseville, CA
- Beverly Rae Abramowitz
- Vera Britto Abreu
- Jynnahlove Abshire
- Mary Abu-Dawood
- Ali H Abughazaleh
- Access Specialty Inc
- Access Specialty Inc
- Access Surgical Care Group, Inc.
- Antonia Accettura
- Accident and Sports Injury Clinic
All providers in Roseville, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.