Individual provider Active NPI

Gregory Michael Yakimec, DPT

  • Physical Therapist
  • Pawtucket, RI
National Provider Identifier
1073998241
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT02773 Issued in RI
Practice address
21 Division St
Pawtucket, RI 02860-5301
Phone
(401) 433-4172
Fax
(401) 433-0612
NPI assigned
Jul 29, 2015
Last updated
Oct 11, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT02773 RI Primary

Addresses

Primary practice location

21 Division St
Pawtucket, RI 02860-5301

Mailing address

1585 Mid Valley Dr
Ste 3
Steamboat Springs, CO 80487-9099
Phone (970) 879-8026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220710000013 NJ Practitioner - Physical Therapist in Private Practice 5496058679 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT02773RIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bay State Physical Therapy PC Physical Therapist CurrentSince Oct 1, 2023 Accepting new patients
Maximum Health Physical Therapy of Long Valley, PC Physical Therapist CurrentSince Jun 23, 2022 Accepting new patients
Jem Physical Therapy, LLC Physical Therapist CurrentSince Jun 10, 2024 Accepting new patients
Maximum Health Physical Therapy LLC Physical Therapist CurrentSince Jun 23, 2022 Accepting new patients
Kowalick LLC Physical Therapist CurrentSince Dec 10, 2023 Accepting new patients

Locations

1585 Mid Valley Dr
Ste 3
Steamboat Springs, CO 80487
Phone (970) 879-8026

197 US Highway 46
Budd Lake, NJ 07828
Phone (973) 347-0500

30 Seminary Ave
Ste 3
Chester, NJ 07930
Phone (908) 295-2287

62 E Mill Rd
Ste A2
Long Valley, NJ 07853
Phone (908) 520-2377

1 Garnett Ln
Greenville, RI 02828
Phone (401) 949-0380

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1073998241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1585 MID VALLEY DR",
            "address_2": "STE 3",
            "city": "STEAMBOAT SPRINGS",
            "state": "CO",
            "postal_code": "804879099",
            "telephone_number": "970-879-8026",
            "fax_number": "970-879-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 DIVISION ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028605301",
            "telephone_number": "401-433-4172",
            "fax_number": "401-433-0612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAKIMEC",
        "first_name": "GREGORY",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-29",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "RI",
            "license": "PT02773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.