NPIMap

Organization Active NPI

Orthopedic Physical Therapy Associates LLC

  • Physical Therapist
  • Lakeland, FL
National Provider Identifier
1114995891
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ORTHOPEDIC PHYSICAL THERAPY ASSOCIATES LLC
Practice address
4720 Cleveland Heights Blvd
Suite 101
Lakeland, FL 33813-2243
Phone
(863) 644-0007
Fax
(863) 644-3377
NPI assigned
Mar 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

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

Authorized official

Name
Patricia Anne Rouleau, PT, OCSNPI 1164490439
Title
Owner
Phone
(863) 644-0007

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 1

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

Addresses

Primary practice location

4720 Cleveland Heights Blvd
Suite 101
Lakeland, FL 33813-2243

Mailing address

4720 Cleveland Heights Blvd
Suite 101
Lakeland, FL 33813-2243
Phone (863) 644-0007

Other identifiers 1

IdentifierTypeStateIssuer
Y917EOtherFLBCBS GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050902000151 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3870525504 Receives reassigned benefits from 5 practitioners
Practice locations: Lakeland, FL

National Provider Directory

National Provider Directory

Locations

4720 Cleveland Heights Blvd
Ste 101
Lakeland, FL 33813
Phone (863) 644-0007

Practitioners & affiliated clinicians

Practitioners 9

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": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1114995891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 CLEVELAND HEIGHTS BLVD",
            "address_2": "SUITE 101",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132243",
            "telephone_number": "863-644-0007",
            "fax_number": "863-644-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 CLEVELAND HEIGHTS BLVD",
            "address_2": "SUITE 101",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132243",
            "telephone_number": "863-644-0007",
            "fax_number": "863-644-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC PHYSICAL THERAPY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "ROULEAU",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-644-0007",
        "authorized_official_credential": "PT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "Y917E",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; 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.