NPIMap

Organization Active NPI

Tallahassee Orthopedic & Sports Physical Therapy

  • Physical Therapist
  • Madison, FL
National Provider Identifier
1104956341
Registry record updated Jul 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Practice address
257 SW Dade St
Madison, FL 32340-2361
Phone
(850) 973-3316
Fax
(850) 973-1261
NPI assigned
Mar 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2009

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

Authorized official

Name
Kent Knisley, P.T.
Title
Ceo
Phone
(850) 973-3316

Specialties & licenses 1

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

Addresses

Primary practice location

257 SW Dade St
Madison, FL 32340-2361

Mailing address

PO Box 13269
Tallahassee, FL 32317-3269
Phone (850) 219-1520

Other identifiers 3

IdentifierTypeStateIssuer
883224200OtherFLPARENT FACILITY MEDICAID ID
883224205MedicaidFL
1376593053OtherFLPARENT FACILITY NPI

Other names 1

  • Madison Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040131000346 FL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3678476017 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Apalachicola, FL; Crawfordville, FL; Tallahassee, FL

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

257 SW Dade St
Madison, FL 32340
Phone (850) 973-3316

1891 Capital Cir NE
Ste 2
Tallahassee, FL 32308
Phone (850) 877-8855

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246492800000",
    "number": "1104956341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13269",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323173269",
            "telephone_number": "850-219-1520",
            "fax_number": "850-219-1521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 SW DADE ST",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "323402361",
            "telephone_number": "850-973-3316",
            "fax_number": "850-973-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2009-07-02",
        "status": "A",
        "authorized_official_last_name": "KNISLEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-973-3316",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARENT FACILITY MEDICAID ID",
            "identifier": "883224200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883224205",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARENT FACILITY NPI",
            "identifier": "1376593053",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; 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.