NPIMap

Organization Active NPI

Physical Therapy Professionals, PC

  • Physical Therapist
  • Lakeville, NY
National Provider Identifier
1083834758
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
012202 Issued in NY
Legal business name
PHYSICAL THERAPY PROFESSIONALS, PC
Practice address
3506 Thomas Dr
Lakeville, NY 14480-9730
Phone
(585) 346-0060
Fax
(585) 346-0108
NPI assigned
Apr 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

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

Authorized official

Name
Mrs. Susan Farrell
Title
Office Manager
Phone
(585) 346-0060

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 012202 NY Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 012242 NY
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 017728 NY
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 023289 NY
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 018661 NY
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 009223 NY
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 026428 NY

Addresses

Primary practice location

3506 Thomas Dr
Lakeville, NY 14480-9730

Mailing address

3506 Thomas Dr
Lakeville, NY 14480-9730
Phone (585) 346-0060

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000409 NY Part B Supplier - Clinic/Group Practice 1153486485 Receives reassigned benefits from 5 practitioners
Practice locations: Caledonia, NY; Lakeville, NY; Mount Morris, NY

National Provider Directory

National Provider Directory

Locations

3163 State St
Caledonia, NY 14423
Phone (585) 538-9460

3163 State St
#5
Caledonia, NY 14423
Phone (585) 538-9460

100 Loder St
Ste 105
Hornell, NY 14843
Phone (607) 324-9344

3506 Thomas Dr
Lakeville, NY 14480
Phone (585) 346-0060

66 Stanley St
Mount Morris, NY 14510
Phone (585) 658-9280

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438732800000",
    "number": "1083834758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3506 THOMAS DR",
            "city": "LAKEVILLE",
            "state": "NY",
            "postal_code": "144809730",
            "telephone_number": "585-346-0060",
            "fax_number": "585-346-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3506 THOMAS DR",
            "city": "LAKEVILLE",
            "state": "NY",
            "postal_code": "144809730",
            "telephone_number": "585-346-0060",
            "fax_number": "585-346-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY PROFESSIONALS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2015-08-05",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "585-346-0060",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "012202",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "012242",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "017728",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "023289",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "018661",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "009223",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "026428",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; 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.