NPIMap

Organization Active NPI

Home-Based Physical Therapy PLLC

  • Physical Therapist
  • Woodmere, NY
National Provider Identifier
1356900989
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
HOME-BASED PHYSICAL THERAPY PLLC
Practice address
104 Combs Ave
Woodmere, NY 11598-1431
Phone
(718) 962-5852
NPI assigned
Jun 7, 2019
Last updated
Sep 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Authorized official

Name
Michelle Fried, DPTNPI 1659510642
Title
President
Phone
(718) 962-5852

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: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

104 Combs Ave
Woodmere, NY 11598-1431

Mailing address

104 Combs Ave
Woodmere, NY 11598-1431
Phone (718) 962-5852

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200511002060 NY Part B Supplier - Clinic/Group Practice 0345671103 Receives reassigned benefits from 26 practitioners
Practice locations: Woodmere, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 49

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.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1356900989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 COMBS AVE",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981431",
            "telephone_number": "718-962-5852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 COMBS AVE",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115981431",
            "telephone_number": "718-962-5852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOME-BASED PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2023-09-29",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "FRIED",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-962-5852",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodmere, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.