NPIMap

Organization Active NPI

Professional Occupational & Physical Therapy, PLLC

  • Occupational Therapist
  • Rockville Centre, NY
National Provider Identifier
1205565496
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Practice address
165 N Village Ave Ste 127
Rockville Centre, NY 11570-3763
Phone
(516) 418-8972
Fax
(516) 418-8976
NPI assigned
Jun 6, 2022
Last updated
Jun 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Authorized official

Name
Kerri Wilkinson
Title
Credentialing Manager
Phone
(631) 359-5859

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

165 N Village Ave Ste 127
Rockville Centre, NY 11570-3763

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5002
Phone (631) 359-5859

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230526000528 NY DME Supplier - Independently-Practicing Occupational Therapist 3779873401 Practice locations: Rockville Centre, NY

National Provider Directory

National Provider Directory
Tax ID family
Prof Occptnl Phyl Thpy119 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654473600000",
    "number": "1205565496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002",
            "telephone_number": "631-359-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N VILLAGE AVE STE 127",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703763",
            "telephone_number": "516-418-8972",
            "fax_number": "516-418-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "631-359-5859"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; 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.