Individual provider Active NPI

Nirajkumar Thakore

  • Physical Therapist
  • Lake Mary, FL
National Provider Identifier
1245459932
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT30291 Issued in FL
Practice address
875 Wallace CT Unit 1013
Lake Mary, FL 32746-2161
Phone
(734) 578-5171
NPI assigned
Apr 24, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT30291 FL Primary
Physical Therapist 225100000X 5501012111 MI

Addresses

Primary practice location

875 Wallace CT Unit 1013
Lake Mary, FL 32746-2161

Mailing address

5205 Piper LN
Sanford, FL 32771-5465

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260227000208 FL Practitioner - Physical Therapist in Private Practice 5991755670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regent Therapy Services LLCGroup PAC ID 4587064571, 2 clinicians

Practice addresses (Care Compare)

875 Wallace CT
Suite C (Unit 1013)
Lake Mary, FL 32746-3274
Phone (813) 843-2401

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT30291FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Regent Therapy Services LLC. Physical Therapist CurrentSince Apr 1, 2021 Accepting new patients

Locations

875 Wallace Ct
Unit 1013
Lake Mary, FL 32746
Phone (734) 578-5171

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1245459932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5205 PIPER LN",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327715465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 WALLACE CT UNIT 1013",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462161",
            "telephone_number": "734-578-5171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAKORE",
        "first_name": "NIRAJKUMAR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT30291",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501012111",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.