Individual provider Active NPI

Geraldine Mary La Grua, PHYSICAL THERAPIST

  • Physical Therapist
  • Staten Island, NY
National Provider Identifier
1205142619
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA00986300 Issued in NJ
Practice address
59 Rolling Hill GRN
Staten Island, NY 10312-1808
Phone
(718) 948-3161
NPI assigned
Aug 23, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 40QA00986300 NJ Primary

Addresses

Primary practice location

59 Rolling Hill GRN
Staten Island, NY 10312-1808

Mailing address

59 Rolling Hill GRN
Staten Island, NY 10312-1808
Phone (718) 948-3161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
022751NYMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282521600000",
    "number": "1205142619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 ROLLING HILL GRN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103121808",
            "telephone_number": "718-948-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 ROLLING HILL GRN",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103121808",
            "telephone_number": "718-948-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA GRUA",
        "first_name": "GERALDINE",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2010-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00986300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; 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.