Active NPI
Tracy Lynn Java, P.T.
- Physical Therapist
- Syracuse, NY
National Provider Identifier
1124161666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 022004-1
- Practice address
- 813 Fay Rd
Syracuse, NY 13219-3009 - Phone
- (315) 488-2951
- NPI assigned
- Feb 15, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 022004-1 | NY | Primary |
Addresses
Primary practice location
813 Fay Rd
Syracuse, NY 13219-3009
Mailing address
105 S Avery Ave
Syracuse, NY 13204-2501
Phone (315) 884-3379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022004-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124161666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 S AVERY AVE",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132042501",
"telephone_number": "315-884-3379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 FAY RD",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132193009",
"telephone_number": "315-488-2951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAVA",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "022004-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.