Olympus PT PC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

032114 Issued in NY

Legal business name

OLYMPUS PT PC

Practice address

694 Fort Salonga Rd
Northport, NY 11768-3147

Phone

(631) 754-3775

Fax

(631) 754-3816

NPI assigned

May 24, 2018

Organization subpart

No

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

Authorized official

Name

Quennie Ladao-Soto, PT

Title

Owner

Phone

(914) 444-6235

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1215428370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 64TH ST APT 1F",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112043449",
            "telephone_number": "914-444-6235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "694 FORT SALONGA RD",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117683147",
            "telephone_number": "631-754-3775",
            "fax_number": "631-754-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPUS PT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "LADAO-SOTO",
        "authorized_official_first_name": "QUENNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-444-6235",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NY",
            "license": "032114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nkemdirim Okoro
• Old Fashioned RX LLC
• Karley Oliva, MA CCC-SLP
• Karen L Olivieri, P.A.
• Nancy P. Olsen, LCSW
• Barbara Joyce Onderdonk, OTR, CHT
• Craig B Ordway, MD
• Kimberly Orth, LCSW
• Lynda Marie Page, C.T.R.S.
• Stacy Sarah Paickattu, DO

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Northport, NY
• Providers in Northport, NY by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; 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.