Buffalo Teletherapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

028310 Issued in NY

Legal business name

BUFFALO TELETHERAPY LLC

Practice address

258 Ashland Ave
Buffalo, NY 14222-1706

Phone

(716) 949-8202

NPI assigned

Mar 25, 2016

Last updated

Jun 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jamie Joseph Park, DPTNPI 1194818401

Title

Owner/Physical Therapist

Phone

(716) 949-8202

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 2

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.

• Jamie Joseph Park, DPT

  • Physical Therapist
  • Owings Mills, MD
  • NPI 1194818401

  NY

  Medicare reassignment NPD Authorized official
• Kelly Diarra, DPT

  • Physical Therapist
  • Buffalo, NY
  • NPI 1376035758
  NPD (past)

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

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1255793550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 ASHLAND AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142221706",
            "telephone_number": "716-949-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 ASHLAND AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142221706",
            "telephone_number": "716-949-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUFFALO TELETHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-25",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "716-949-8202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "028310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1194818401",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; 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.