NPIMap

Organization Active NPI

Star Physical Therapy PLLC

  • Orthopedic Physical Therapist
  • Fairport, NY
National Provider Identifier
1003962523
Registry record updated Mar 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Legal business name
STAR PHYSICAL THERAPY PLLC
Practice address
790 Ayrault Road
Fairport, NY 14450
Phone
(585) 425-1018
Fax
(585) 425-8955
NPI assigned
Jan 26, 2007
Last updated
Mar 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2013

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

Authorized official

Name
Mrs. Marcia Spoto, PT, DC, OCSNPI 1831399906
Title
Director
Phone
(585) 425-1018

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X Primary

Addresses

Primary practice location

790 Ayrault Road
Fairport, NY 14450

Mailing address

790 Ayrault Road
Fairport, NY 14450
Phone (585) 425-1018

Other identifiers 2

IdentifierTypeStateIssuer
103116FTOtherNYPREFILLED CARE
G0187891590OtherNYBLUE CHOICE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000776 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0648238832 Receives reassigned benefits from 7 practitioners
Practice locations: Fairport, NY

National Provider Directory

National Provider Directory

Locations

790 Ayrault Rd
Ste 2
Fairport, NY 14450
Phone (585) 425-1018

790 Ayrault Rd
Fairport, NY 14450
Phone (585) 425-1018

1161 N Greece Rd
Rochester, NY 14626

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362441600000",
    "number": "1003962523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 AYRAULT ROAD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "14450",
            "telephone_number": "585-425-1018",
            "fax_number": "585-425-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 AYRAULT ROAD",
            "city": "FAIRPORT",
            "state": "NY",
            "postal_code": "14450",
            "telephone_number": "585-425-1018",
            "fax_number": "585-425-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2013-03-05",
        "status": "A",
        "authorized_official_last_name": "SPOTO",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "585-425-1018",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, DC, OCS"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFILLED CARE",
            "identifier": "103116FT",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "G0187891590",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; 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.