NPIMap

Organization Active NPI

Latitude Physical Therapy

  • Physical Therapist
  • Sag Harbor, NY
National Provider Identifier
1326816992
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LATITUDE PHYSICAL THERAPY
Practice address
34 Bay St Ste 205-206
Sag Harbor, NY 11963-3104
Phone
(631) 241-3698
NPI assigned
Dec 13, 2023
Last updated
Feb 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Authorized official

Name
George Jay WilsonNPI 1942591672
Title
Ceo
Phone
(631) 919-5189

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

34 Bay St Ste 205-206
Sag Harbor, NY 11963-3104

Mailing address

PO Box 552
Sag Harbor, NY 11963-0012
Phone (631) 903-7996

Other practice location 1

315 Madison Ave Rm 702
New York, NY 10017-5434
Phone (631) 903-7996

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240201002501 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7810340296 Receives reassigned benefits from 8 practitioners
Practice locations: New York, NY; Sag Harbor, NY; Southampton, NY

National Provider Directory

National Provider Directory

Locations

34 Bay St
#205206
Sag Harbor, NY 11963
Phone (631) 919-5189

34 Bay St
Ste 205206
Sag Harbor, NY 11963
Phone (631) 241-3698

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1702425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1326816992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 552",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119630012",
            "telephone_number": "631-903-7996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 BAY ST STE 205-206",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119633104",
            "telephone_number": "631-241-3698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Madison Ave Rm 702",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100175434",
            "country_code": "US",
            "telephone_number": "631-903-7996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LATITUDE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-13",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "631-919-5189"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sag Harbor, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; 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.