Active NPI
Traci Holland-Vincent, PT
- Physical Therapist
- Riverside, CA
National Provider Identifier
1982835773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT15473
- Practice address
- 5225 Canyon Crest Dr
Suite 205
Riverside, CA 92507-6301 - Phone
- (951) 683-3309
- Fax
- (951) 683-1886
- NPI assigned
- Jul 28, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT15473 | CA | Primary |
Addresses
Primary practice location
5225 Canyon Crest Dr
Suite 205
Riverside, CA 92507-6301
Mailing address
5225 Canyon Crest Dr
Suite 205
Riverside, CA 92507-6301
Phone (951) 683-3309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15473 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| PT15473 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedic Physical Therapy Institute | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Riverside, CA
- NPI 1770700023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248739200000",
"number": "1982835773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5225 CANYON CREST DR",
"address_2": "SUITE 205",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076301",
"telephone_number": "951-683-3309",
"fax_number": "951-683-1886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 CANYON CREST DR",
"address_2": "SUITE 205",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925076301",
"telephone_number": "951-683-3309",
"fax_number": "951-683-1886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLAND-VINCENT",
"first_name": "TRACI",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-28",
"last_updated": "2009-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT15473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.