Organization Active NPI

Pro-Active Physical Therapy and Athletic Training, PLLC

  • Athletic Trainer
  • Cobleskill, NY
National Provider Identifier
1073670402
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
Legal business name
PRO-ACTIVE PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC
Practice address
2403 State Route 7
Store #5
Cobleskill, NY 12043-5740
Phone
(518) 234-7760
NPI assigned
Jan 3, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Randall Pacatte, PTNPI 1093872426
Title
Owner
Phone
(518) 234-7760

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU
Athletic Trainer 2255A2300X NU Primary

Addresses

Primary practice location

2403 State Route 7
Store #5
Cobleskill, NY 12043-5740

Mailing address

2403 State Route 7
Store #5
Cobleskill, NY 12043-5740
Phone (518) 234-7760

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070717000624 NY Part B Supplier - Clinic/Group Practice 7012017288 Receives reassigned benefits from 2 practitioners
Practice locations: Cobleskill, NY

National Provider Directory

National Provider Directory

Locations

2403 State Route 7
Cobleskill, NY 12043
Phone (518) 234-7760

2403 State Route 7
Ste 5
Cobleskill, NY 12043
Phone (518) 234-4316

Practitioners & affiliated clinicians

Practitioners 2

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": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1073670402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 STATE ROUTE 7",
            "address_2": "STORE #5",
            "city": "COBLESKILL",
            "state": "NY",
            "postal_code": "120435740",
            "telephone_number": "518-234-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 STATE ROUTE 7",
            "address_2": "STORE #5",
            "city": "COBLESKILL",
            "state": "NY",
            "postal_code": "120435740",
            "telephone_number": "518-234-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-ACTIVE PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "PACATTE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-234-7760",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cobleskill, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.