NPIMap

Organization Active NPI

Upstate Physical Therapy PC

  • Physical Therapist
  • Denton, TX
National Provider Identifier
1053417410
Registry record updated Apr 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
655410000 Issued in TX
Legal business name
UPSTATE PHYSICAL THERAPY PC
Practice address
4401 North I-35
Suite 110
Denton, TX 76207
Phone
(940) 483-9020
Fax
(940) 483-9021
NPI assigned
Sep 15, 2006
Last updated
Apr 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2013

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

Authorized official

Name
Mr. Matthew Lawrence Infanzon, P TNPI 1346259587
Title
Owner Physical Therapist
Phone
(940) 483-9020

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
Physical Therapist 225100000X 655410000 TX Primary

Addresses

Primary practice location

4401 North I-35
Suite 110
Denton, TX 76207

Mailing address

4401 North I-35
Suite 110
Denton, TX 76207
Phone (940) 483-9020

Other identifiers 2

IdentifierTypeStateIssuer
4LVOtherTXBCBS OF TX GROUP NUMBER
168705501MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041115000974 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052375557 Receives reassigned benefits from 6 practitioners
Practice locations: Denton, TX; Plano, TX; Richardson, TX

National Provider Directory

National Provider Directory

Locations

4401 N Interstate 35
Unit 110
Denton, TX 76207
Phone (940) 483-9020

2301 Ohio Dr
Ste 133
Plano, TX 75093
Phone (972) 398-7881

1701 Gateway Blvd
Ste 32
Richardson, TX 75080
Phone (972) 238-2841

1701 Gateway Blvd
Ste 321
Richardson, TX 75080
Phone (972) 238-2841

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1053417410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 NORTH I-35",
            "address_2": "SUITE 110",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "76207",
            "telephone_number": "940-483-9020",
            "fax_number": "940-483-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 NORTH I-35",
            "address_2": "SUITE 110",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "76207",
            "telephone_number": "940-483-9020",
            "fax_number": "940-483-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "INFANZON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "940-483-9020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P T"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "655410000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TX GROUP NUMBER",
            "identifier": "4LV",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168705501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.