NPIMap

Organization Active NPI

Magnolia Physical Therapy, Inc

Doing business as Anaheim Physical Therapy and Aquatic Rehab

  • Clinic/Center
  • Huntington Beach, CA
National Provider Identifier
1982642336
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
A165984 Issued in CA
Legal business name
MAGNOLIA PHYSICAL THERAPY, INC
Doing business as
Anaheim Physical Therapy and Aquatic Rehab
Practice address
19032 Magnolia St
Huntington Beach, CA 92646-2232
Phone
(714) 968-3003
Fax
(714) 968-4220
NPI assigned
Jun 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Mrs. Carol M. Fracalosy, P.T.
Title
Owner
Phone
(714) 968-3003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X A165984 CA Primary

Addresses

Primary practice location

19032 Magnolia St
Huntington Beach, CA 92646-2232

Mailing address

19032 Magnolia St
Huntington Beach, CA 92646-2232
Phone (714) 968-3003

Other names 1

  • Anaheim Physical Therapy and Aquatic Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129001233 CA Part B Supplier - Clinic/Group Practice 0840193561 Receives reassigned benefits from 8 practitioners
Practice locations: Huntington Beach, CA

National Provider Directory

National Provider Directory
Tax ID family
Anaheim Physical Therapy and Aquatic Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

19032 Magnolia St
Huntington Beach, CA 92646
Phone (714) 968-3003

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1982642336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19032 MAGNOLIA ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926462232",
            "telephone_number": "714-968-3003",
            "fax_number": "714-968-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19032 MAGNOLIA ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926462232",
            "telephone_number": "714-968-3003",
            "fax_number": "714-968-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "FRACALOSY",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-968-3003",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A165984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anaheim Physical Therapy and Aquatic Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.