Organization Active NPI

Northern Physical Therapy, LLC

  • Physical Therapist
  • Ogdensburg, NY
National Provider Identifier
1174624969
Registry record updated Jun 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
011013 Issued in NY
Legal business name
NORTHERN PHYSICAL THERAPY, LLC
Practice address
203 State St
Ogdensburg, NY 13669-1403
Phone
(315) 393-2024
Fax
(315) 393-2025
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2015

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

Authorized official

Name
Mrs. Jeanine Ruth McLellan, PTNPI 1942301635
Title
Owner
Phone
(315) 393-2024

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 011013 NY Primary

Addresses

Primary practice location

203 State St
Ogdensburg, NY 13669-1403

Mailing address

203 State St
Ogdensburg, NY 13669-1403
Phone (315) 393-2024

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713000295 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5092793398 Receives reassigned benefits from 10 practitioners
Practice locations: Clayton, NY; Evans Mills, NY; Ogdensburg, NY

National Provider Directory

National Provider Directory
Tax ID family
Northern Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

229 John St
Clayton, NY 13624

307 Riverside Dr
Clayton, NY 13624
Phone (315) 285-5159

26908 Independence Way
Ste 201
Evans Mills, NY 13637
Phone (315) 629-6255

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435017600000",
    "number": "1174624969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 STATE ST",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136691403",
            "telephone_number": "315-393-2024",
            "fax_number": "315-393-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 STATE ST",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136691403",
            "telephone_number": "315-393-2024",
            "fax_number": "315-393-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2015-06-23",
        "status": "A",
        "authorized_official_last_name": "MCLELLAN",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-393-2024",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "011013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogdensburg, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.