NPIMap

Organization Active NPI

Smiths Grove Physical Therapy

  • Physical Therapist
  • Smiths Grove, KY
National Provider Identifier
1295962124
Registry record updated Feb 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
004222 Issued in KY
Legal business name
SMITHS GROVE PHYSICAL THERAPY
Practice address
111 College Street
Smiths Grove, KY 42171
Phone
(270) 563-2084
Fax
(270) 563-2085
NPI assigned
Jun 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2010

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

Authorized official

Name
Mr. Jeremy Logan Schafer, PT, OCS, ECSNPI 1326092446
Title
Owner/Member
Phone
(270) 563-2084

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 004222 KY Primary
Clinical Electrophysiology Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251E1300X 004222 KY
Sports Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251S0007X 004222 KY
Orthopedic Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251X0800X 004222 KY

Addresses

Primary practice location

111 College Street
Smiths Grove, KY 42171

Mailing address

PO Box 157
Brownsville, KY 42210-0157
Phone (270) 563-2084

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090808000002 KY Part B Supplier - Clinic/Group Practice 8426101460 Receives reassigned benefits from 2 practitioners
Practice locations: Smiths Grove, KY

National Provider Directory

National Provider Directory

Locations

111 College St
Smiths Grove, KY 42171
Phone (270) 563-2084

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266278400000",
    "number": "1295962124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "city": "BROWNSVILLE",
            "state": "KY",
            "postal_code": "422100157",
            "telephone_number": "270-563-2084",
            "fax_number": "270-563-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLLEGE STREET",
            "city": "SMITHS GROVE",
            "state": "KY",
            "postal_code": "42171",
            "telephone_number": "270-563-2084",
            "fax_number": "270-563-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITHS GROVE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2010-02-16",
        "status": "A",
        "authorized_official_last_name": "SCHAFER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "LOGAN",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "270-563-2084",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, OCS, ECS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "004222",
            "primary": true
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": "KY",
            "license": "004222",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "KY",
            "license": "004222",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "KY",
            "license": "004222",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smiths Grove, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; 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.