NPIMap

Organization Active NPI

Lakeside Physical Therapy, LLC

  • Rehabilitation Practitioner
  • Laurel, DE
National Provider Identifier
1184854929
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
Legal business name
LAKESIDE PHYSICAL THERAPY, LLC
Practice address
404 E Front St
Laurel, DE 19956-1741
Phone
(302) 280-6920
Fax
(302) 280-6921
NPI assigned
Jul 14, 2009
Last updated
Apr 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Authorized official

Name
Mr. Metodio Amahit Pamplona Jr., P.T.NPI 1548494297
Title
Owner
Phone
(302) 280-6920

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X NU Primary
Physical Therapy Clinic/Center 261QP2000X 2009603216 DE

Addresses

Primary practice location

404 E Front St
Laurel, DE 19956-1741

Mailing address

404 E Front St
Laurel, DE 19956-1741
Phone (302) 280-6920

Other practice location 1

24488 Sussex Hwy Ste 2
Seaford, DE 19973-8470
Phone (302) 990-5544

Other identifiers 2

IdentifierTypeStateIssuer
1548466550OtherDENPI
1548494297OtherDENPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090908000525 DE Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1658426093 Receives reassigned benefits from 10 practitioners
Practice locations: Laurel, DE; Seaford, DE; Milford, DE

National Provider Directory

National Provider Directory

Locations

404 E Front St
Laurel, DE 19956
Phone (302) 280-6920

24488 Sussex Hwy
Ste 2
Seaford, DE 19973
Phone (302) 629-5766

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1184854929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E FRONT ST",
            "city": "LAUREL",
            "state": "DE",
            "postal_code": "199561741",
            "telephone_number": "302-280-6920",
            "fax_number": "302-280-6921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 E FRONT ST",
            "city": "LAUREL",
            "state": "DE",
            "postal_code": "199561741",
            "telephone_number": "302-280-6920",
            "fax_number": "302-280-6921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24488 Sussex Hwy Ste 2",
            "address_purpose": "LOCATION",
            "city": "Seaford",
            "state": "DE",
            "postal_code": "199738470",
            "country_code": "US",
            "telephone_number": "302-990-5544",
            "fax_number": "302-990-5545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-14",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "PAMPLONA",
        "authorized_official_first_name": "METODIO",
        "authorized_official_middle_name": "AMAHIT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-280-6920",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "DE",
            "license": "2009603216",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548466550",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548494297",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.