Jade Physical Therapy PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

JADE PHYSICAL THERAPY PC

Practice address

557 Oak St
Copiague, NY 11726-3215

Phone

(631) 464-4700

NPI assigned

Dec 5, 2012

Organization subpart

No

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

Authorized official

Name

Maricel De Vera

Title

PT

Phone

(347) 993-8251

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354665600000",
    "number": "1154666972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 OAK ST",
            "city": "COPIAGUE",
            "state": "NY",
            "postal_code": "117263215",
            "telephone_number": "631-464-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 OAK ST",
            "city": "COPIAGUE",
            "state": "NY",
            "postal_code": "117263215",
            "telephone_number": "631-464-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JADE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-05",
        "last_updated": "2012-12-05",
        "status": "A",
        "authorized_official_last_name": "DE VERA",
        "authorized_official_first_name": "MARICEL",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "347-993-8251"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Walter Hodyl, M.D.
• Debra Marie Hoffmann
• Tracy Holland, LMSW
• Henry Hollingsworth
• Nicole Hovey, ATC
• Marika Jagielska
• Elaine James, R.N.
• Mary Johnson, PTA
• Tiffany M Johnson, COTA
• Kuruvilla Jose, LMSW

• Physical Therapy Clinic/Center in Copiague, NY
• Providers in Copiague, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.