Active NPI
Robert C Gautreau, PHYSICAL THERAPIST
- Physical Therapist
- Ticonderoga, NY
National Provider Identifier
1356077929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 012163-1
- Practice address
- 262 Shore Airport Rd
Ticonderoga, NY 12883-2907 - Phone
- (518) 207-5488
- Fax
- (518) 585-3263
- NPI assigned
- Jul 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 012163-1 | NY | Primary |
Addresses
Primary practice location
262 Shore Airport Rd
Ticonderoga, NY 12883-2907
Mailing address
262 Shore Airport Rd
Ticonderoga, NY 12883-2907
Phone (518) 207-5488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012163-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658793600000",
"number": "1356077929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "262 SHORE AIRPORT RD",
"city": "TICONDEROGA",
"state": "NY",
"postal_code": "128832907",
"telephone_number": "518-207-5488",
"fax_number": "518-585-3263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "262 SHORE AIRPORT RD",
"city": "TICONDEROGA",
"state": "NY",
"postal_code": "128832907",
"telephone_number": "518-207-5488",
"fax_number": "518-585-3263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAUTREAU",
"first_name": "ROBERT",
"middle_name": "C",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-07-26",
"last_updated": "2022-07-26",
"certification_date": "2022-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "012163-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ticonderoga, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.