NPIMap

Organization Active NPI

Sports Therapy Albany P.T, P.C.

Doing business as Albany Physical Therapy

  • Physical Therapist
  • Albany, NY
National Provider Identifier
1063541332
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPORTS THERAPY ALBANY P.T, P.C.
Doing business as
Albany Physical Therapy
Practice address
4 Executive Park Dr
Albany, NY 12203-3718
Phone
(518) 489-2449
Fax
(518) 489-2991
NPI assigned
Mar 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Thomas F. Fashouer, ATCNPI 1154314805
Title
Director of Rehabilitation
Phone
(518) 489-2449

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

4 Executive Park Dr
Albany, NY 12203-3718

Mailing address

4 Executive Park Dr
Albany, NY 12203-3718
Phone (518) 489-2449

Other names 1

  • Albany Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505001141 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6709874811 Receives reassigned benefits from 2 practitioners
Practice locations: Albany, NY

National Provider Directory

National Provider Directory
Tax ID family
Albany Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4 Executive Park Dr
Ste 13
Albany, NY 12203
Phone (518) 489-2449

Practitioners & affiliated clinicians

Practitioners 6

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": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063541332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 EXECUTIVE PARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033718",
            "telephone_number": "518-489-2449",
            "fax_number": "518-489-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 EXECUTIVE PARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033718",
            "telephone_number": "518-489-2449",
            "fax_number": "518-489-2991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS THERAPY ALBANY P.T, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FASHOUER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "DIRECTOR OF REHABILITATION",
        "authorized_official_telephone_number": "518-489-2449",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Albany Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.