Innovative Pediatric Therapies PT OT SLP PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

009027-1 Issued in NY

Legal business name

INNOVATIVE PEDIATRIC THERAPIES PT OT SLP PLLC

Practice address

31 Burd St
Nyack, NY 10960-3205

Phone

(845) 353-3331

NPI assigned

Jun 20, 2011

Organization subpart

No

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

Authorized official

Name

Lise Petricone, PT, PCS

Title

President

Phone

(845) 353-3331

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316736000000",
    "number": "1023304995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 BURD STREET",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "10960",
            "telephone_number": "845-353-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 BURD ST",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109603205",
            "telephone_number": "845-353-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PEDIATRIC THERAPIES PT OT SLP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-09-23",
        "status": "A",
        "authorized_official_last_name": "PETRICONE",
        "authorized_official_first_name": "LISE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-353-3331",
        "authorized_official_credential": "PT, PCS"
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NY",
            "license": "003760-1",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "009027-1",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NY",
            "license": "005413-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lydia Isak, COTA
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• Physical Therapy Clinic/Center in Nyack, NY
• Providers in Nyack, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; 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.