Individual provider Active NPI

Walter Brown, PT

  • Physical Therapist
  • Williamsville, NY
National Provider Identifier
1013944529
Registry record updated Nov 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
010092 Issued in NY
Practice address
100 College Pkwy
Suite 100
Williamsville, NY 14221-6800
Phone
(716) 626-0093
Fax
(716) 626-9193
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 010092 NY Primary

Addresses

Primary practice location

100 College Pkwy
Suite 100
Williamsville, NY 14221-6800

Mailing address

100 College Pkwy
Suite 100
Williamsville, NY 14221-6800
Phone (716) 626-0093

Other identifiers 1

IdentifierTypeStateIssuer
01394045MedicaidNY

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

LicenseStateTypeSpecialty
0100921NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Physical Therapy of New York, P.C. Physical Therapist PastSince Apr 1, 2003 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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194566400000",
    "number": "1013944529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COLLEGE PKWY",
            "address_2": "SUITE 100",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216800",
            "telephone_number": "716-626-0093",
            "fax_number": "716-626-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COLLEGE PKWY",
            "address_2": "SUITE 100",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216800",
            "telephone_number": "716-626-0093",
            "fax_number": "716-626-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "WALTER",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "010092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01394045",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2007; 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.