NPIMap

Organization Active NPI

Physical Therapy at Oakdale

Doing business as Oakdale Physical Therapy & Fitness

  • Physical Therapist
  • Johnson City, NY
National Provider Identifier
1073554788
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL THERAPY AT OAKDALE
Doing business as
Oakdale Physical Therapy & Fitness
Practice address
153 Oakdale Road
Suite 2
Johnson City, NY 13790
Phone
(607) 217-0827
Fax
(607) 217-0829
NPI assigned
Jun 10, 2006
Last updated
Jan 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

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

Authorized official

Name
Mr. John K Koniuto, DPTNPI 1598767121
Title
Owner
Phone
(607) 217-0827

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

153 Oakdale Road
Suite 2
Johnson City, NY 13790

Mailing address

153 Oakdale Road
Suite 2
Johnson City, NY 13790
Phone (607) 217-0827

Other names 1

  • Oakdale Physical Therapy & Fitness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040814000119 NY Part B Supplier - Clinic/Group Practice 2466425889 Receives reassigned benefits from 3 practitioners
Practice locations: Johnson City, NY

National Provider Directory

National Provider Directory

Locations

153 Oakdale Rd
Johnson City, NY 13790
Phone (607) 748-9001

153 Oakdale Rd
Ste 2
Johnson City, NY 13790
Phone (607) 217-0827

216 Reynolds Rd
Johnson City, NY 13790
Phone (607) 217-0827

Practitioners & affiliated clinicians

Practitioners 8

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": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579046400000",
    "number": "1073554788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 OAKDALE ROAD",
            "address_2": "SUITE 2",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "13790",
            "telephone_number": "607-217-0827",
            "fax_number": "607-217-0829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 OAKDALE ROAD",
            "address_2": "SUITE 2",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "13790",
            "telephone_number": "607-217-0827",
            "fax_number": "607-217-0829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY AT OAKDALE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A",
        "authorized_official_last_name": "KONIUTO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-217-0827",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakdale Physical Therapy & Fitness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.