NPIMap

Organization Active NPI

Tallahassee Orthopedic & Sports Physical Therapy

  • Physical Therapist
  • Crawfordville, FL
National Provider Identifier
1114057957
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
2887 Crawfordville Highway
Dubreja Plaza, Suite 3
Crawfordville, FL 32327
Phone
(850) 926-8555
Fax
(850) 926-2402
NPI assigned
Mar 7, 2007
Last updated
Jul 2, 2009By the provider in NPPES
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.NPI 1922137934
Title
Owner
Phone
(850) 926-8855

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
Physical Therapist 225100000X FL Primary

Addresses

Primary practice location

2887 Crawfordville Highway
Dubreja Plaza, Suite 3
Crawfordville, FL 32327

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
883224200OtherFLPARENT FACILITY MEDICAID
1376593053OtherFLPARENT FACILITY NPI
883224201MedicaidFL

Other names 1

  • Crawfordville 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
Tax ID family
Tallahassee Orthopedic Sports Physical Therapy10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246492800000",
    "number": "1114057957",
    "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": "2887 CRAWFORDVILLE HIGHWAY",
            "address_2": "DUBREJA PLAZA, SUITE 3",
            "city": "CRAWFORDVILLE",
            "state": "FL",
            "postal_code": "32327",
            "telephone_number": "850-926-8555",
            "fax_number": "850-926-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-07-02",
        "status": "A",
        "authorized_official_last_name": "KNISLEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-926-8855",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARENT FACILITY MEDICAID",
            "identifier": "883224200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARENT FACILITY NPI",
            "identifier": "1376593053",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883224201",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crawfordville Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Crawfordville, 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.