NPIMap

Organization Active NPI

Clifton Park Physical Therapy PLLC

  • Physical Therapist
  • Clifton Park, NY
National Provider Identifier
1154629715
Registry record updated Jun 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
019934-1 Issued in NY
Legal business name
CLIFTON PARK PHYSICAL THERAPY PLLC
Practice address
4 Emma LN
Suite 401
Clifton Park, NY 12065-3763
Phone
(518) 383-2610
Fax
(518) 383-8118
NPI assigned
Mar 7, 2011
Last updated
Jun 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2011

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

Authorized official

Name
Mrs. Kristine Margaret Wanmer, PHYSICAL THERAPISTNPI 1518916238
Title
Owner
Phone
(518) 383-2610

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 Therapist 225100000X 019934-1 NY Primary

Addresses

Primary practice location

4 Emma LN
Suite 401
Clifton Park, NY 12065-3763

Mailing address

4 Emma LN
Suite 401
Clifton Park, NY 12065-3763
Phone (518) 383-2610

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110609000748 NY Part B Supplier - Clinic/Group Practice 2769669266 Receives reassigned benefits from 4 practitioners
Practice locations: Clifton Park, NY

National Provider Directory

National Provider Directory

Locations

4 Emma Ln
Clifton Park, NY 12065

4 Emma Ln
Ste 401
Clifton Park, NY 12065
Phone (518) 383-2610

Practitioners & affiliated clinicians

Practitioners 4

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": "1299456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307664000000",
    "number": "1154629715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 EMMA LN",
            "address_2": "SUITE 401",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653763",
            "telephone_number": "518-383-2610",
            "fax_number": "518-383-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 EMMA LN",
            "address_2": "SUITE 401",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653763",
            "telephone_number": "518-383-2610",
            "fax_number": "518-383-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLIFTON PARK PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-07",
        "last_updated": "2011-06-10",
        "status": "A",
        "authorized_official_last_name": "WANMER",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "MARGARET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-383-2610",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "019934-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clifton Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2011; 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.