NPIMap

Organization Active NPI

Tallahassee Orthopedic & Sports Physical Therapy, LLC

  • Physical Therapist
  • Tallahassee, FL
National Provider Identifier
1376593053
Registry record updated Mar 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, LLC
Practice address
1891 Capital Cir NE Ste 2
Tallahassee, FL 32308-4486
Phone
(850) 877-8855
Fax
(850) 877-7627
NPI assigned
May 11, 2006
Last updated
Mar 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2020

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

Authorized official

Name
Mr. Kent Knisley, D.P.T.NPI 1922137934
Title
Ceo
Phone
(850) 877-8855

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 Therapist 225100000X FL Primary

Addresses

Primary practice location

1891 Capital Cir NE Ste 2
Tallahassee, FL 32308-4486

Mailing address

PO Box 13269
Tallahassee, FL 32317-3269

Other practice location 1

2887 Crawfordville Hwy Unit 3
Crawfordville, FL 32327-2381
Phone (850) 926-8555

Other practice location 2

456 W Base St
Madison, FL 32340-2061
Phone (850) 973-3316

Other identifiers 1

IdentifierTypeStateIssuer
883224200MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040131000346 FL Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3678476017 5 other NPIs on this enrollment
Practice locations: Apalachicola, FL; Crawfordville, FL; Tallahassee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376593053. Details of each certification follow.

  • CCN 106822 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 106822

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jun 29, 1993
Last certification
Feb 27, 2020
Ownership / control type
Proprietary
Facility address
1891 Capital Circle NE
Tallahassee, FL 32308

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tallahassee Orthopedic Sports Physical Therapy LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2887 Crawfordville Hwy
Unit 3
Crawfordville, FL 32327
Phone (850) 922-6855

2121 W Tennessee St
Unit 3
Tallahassee, FL 32304
Phone (850) 985-9221

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585267200000",
    "number": "1376593053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13269",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323173269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 CAPITAL CIR NE STE 2",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084486",
            "telephone_number": "850-877-8855",
            "fax_number": "850-877-7627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2887 Crawfordville Hwy Unit 3",
            "address_purpose": "LOCATION",
            "city": "Crawfordville",
            "state": "FL",
            "postal_code": "323272381",
            "country_code": "US",
            "telephone_number": "850-926-8555",
            "fax_number": "850-926-2402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "456 W Base St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "FL",
            "postal_code": "323402061",
            "country_code": "US",
            "telephone_number": "850-973-3316",
            "fax_number": "850-973-1281",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TALLAHASSEE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A",
        "authorized_official_last_name": "KNISLEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-877-8855",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883224200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.