NPIMap

Organization Active NPI

Lake Country Physical Therapy & Sportscare, PC

  • Physical Therapist
  • Canandaigua, NY
National Provider Identifier
1003958653
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LAKE COUNTRY PHYSICAL THERAPY & SPORTSCARE, PC
Practice address
241 Parrish St
Suite a
Canandaigua, NY 14424-1727
Phone
(585) 396-1400
Fax
(585) 396-3368
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Ms. Zoe Fackelman, PT
Title
President
Phone
(585) 396-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

241 Parrish St
Suite a
Canandaigua, NY 14424-1727

Mailing address

241 Parrish St
Suite a
Canandaigua, NY 14424-1727
Phone (585) 396-1400

Other identifiers 3

IdentifierTypeStateIssuer
5776378OtherNYRCIPPAE
G0185178590OtherNYBLUE CHOICE
01608671MedicaidNY

National Provider Directory

National Provider Directory

Locations

241 Parrish St
Ste A
Canandaigua, NY 14424
Phone (585) 396-1400

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1003958653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 PARRISH ST",
            "address_2": "SUITE A",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241727",
            "telephone_number": "585-396-1400",
            "fax_number": "585-396-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 PARRISH ST",
            "address_2": "SUITE A",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241727",
            "telephone_number": "585-396-1400",
            "fax_number": "585-396-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY PHYSICAL THERAPY & SPORTSCARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "FACKELMAN",
        "authorized_official_first_name": "ZOE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-396-1400",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RCIPPAE",
            "identifier": "5776378",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "G0185178590",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01608671",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canandaigua, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.