Autumn Terwilliger, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

045174 Issued in NY

Practice address

2561 Lac de Ville Blvd Ste 100
Rochester, NY 14618-5645

Phone

(585) 473-1290

NPI assigned

Nov 21, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Autumn Hansen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fairport Physical Therapy, PC

  • Physical Therapist
  • Fairport, NY
  • NPI 1215218870
  NPD (past)

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

{
    "created_epoch": "1574294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1184260473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2561 LAC DE VILLE BLVD STE 100",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185645",
            "telephone_number": "585-473-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2561 LAC DE VILLE BLVD STE 100",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146185645",
            "telephone_number": "585-473-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERWILLIGER",
        "first_name": "AUTUMN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-21",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "045174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "HANSEN",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kanesha Jenise Terry
• Kelsey Terry
• Lucas Terry
• Tracy Terry
• Michael Jarrett Tersigni, CASAC 2
• Kylie Terwilliger, PA-C
• Megan M Terwilliger, MD
• Maddison Mae Terzo, LCSW
• Ruta Mesgina Tesfatsion
• Mahelet M Tesfaye

• Physical Therapist in Rochester, NY
• Providers in Rochester, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.