Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Phaysane Oudom, DPT

Individual provider Physical Therapist · NPI 1265658405

Mr. Phaysane Oudom, DPT is a Physical Therapist in Private Practice in LA Mesa, California. Qualified in 2005, 21 years ago. Practices with Sharp Rees-Stealy Medical Group Inc, a 874-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
21
Licensed in
CA
In the registry since
2007
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

7862 El Cajon Blvd
LA Mesa, CA 91941-3625
Phone: (619) 644-6452
Fax: (619) 466-7528
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT 32527 (CA)

Record details

NPI number1265658405
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedApril 17, 2007
Last updated in NPPESJuly 8, 2007
Mailing address6529 Reflection Dr Apt 114, San Diego, CA 92124-3174

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Sharp Rees-Stealy Medical Group Inc — 874 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in LA Mesa