Provider Demographics
NPI:1801871983
Name:SOMERNDIKE, JOHN MASON (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MASON
Last Name:SOMERNDIKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 N WANDA RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5343
Mailing Address - Country:US
Mailing Address - Phone:714-771-7047
Mailing Address - Fax:714-771-7051
Practice Address - Street 1:1421 N WANDA RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5343
Practice Address - Country:US
Practice Address - Phone:714-771-7047
Practice Address - Fax:714-771-7051
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT27237AMedicare PIN
CABI566ZMedicare PIN