Jennifer Joan Lipa Gruttadaro, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

026676 Issued in NY

Practice address

258 Penbrooke Dr
Penfield, NY 14526-2022

Phone

(347) 341-3501

NPI assigned

Jan 20, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Jennifer Joan De Guzman Lipa Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1200787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1326224379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 PENBROOKE DR",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145262022",
            "telephone_number": "347-341-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 PENBROOKE DR",
            "city": "PENFIELD",
            "state": "NY",
            "postal_code": "145262022",
            "telephone_number": "347-341-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUTTADARO",
        "first_name": "JENNIFER JOAN",
        "middle_name": "LIPA",
        "name_prefix": "Mrs.",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-20",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "026676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER JOAN",
            "last_name": "LIPA",
            "middle_name": "DE GUZMAN",
            "prefix": "MISS",
            "credential": "RPT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Physical Therapist in Penfield, NY
• Providers in Penfield, 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 Sep 6, 2023; 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.