NPIMap

Organization Active NPI

Protherapy Rehabilitation OT, PT, SLP, PLLC

  • Rehabilitation Clinic/Center
  • Bronx, NY
National Provider Identifier
1396022752
Registry record updated Nov 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
010144 Issued in NY
Legal business name
PROTHERAPY REHABILITATION OT, PT, SLP, PLLC
Practice address
866 E Tremont Ave
Bronx, NY 10460-4201
Phone
(718) 589-2200
NPI assigned
Nov 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2011

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

Authorized official

Name
Ms. Russalette Magbanua, MPS, OTR/L, CHTNPI 1932277704
Title
Clinical Director
Phone
(917) 459-3695

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing and Speech Clinic/Center 261QH0700X 012509 NY
Physical Therapy Clinic/Center 261QP2000X 022020 NY
Rehabilitation Clinic/Center 261QR0400X 010144 NY Primary

Addresses

Primary practice location

866 E Tremont Ave
Bronx, NY 10460-4201

Mailing address

866 E Tremont Ave
Bronx, NY 10460-4201
Phone (718) 589-2200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120112000564 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2860669975 Receives reassigned benefits from 12 practitioners
Practice locations: Bronx, NY

National Provider Directory

National Provider Directory

Locations

888 E 163rd St
#3
Bronx, NY 10459
Phone (718) 589-2200

1981 Jerome Ave
#1983
Bronx, NY 10453

1981 Jerome Ave
Bronx, NY 10453
Phone (718) 589-2200

3050 White Plains Rd
Bronx, NY 10467
Phone (718) 655-5444

866 E Tremont Ave
#1
Bronx, NY 10460
Phone (718) 589-2200

274 W 145th St
Ste 310
New York, NY 10039
Phone (212) 368-7800

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1321056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321056000000",
    "number": "1396022752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "866 E TREMONT AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604201",
            "telephone_number": "718-589-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "866 E TREMONT AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104604201",
            "telephone_number": "718-589-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTHERAPY REHABILITATION OT, PT, SLP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-12",
        "last_updated": "2011-11-12",
        "status": "A",
        "authorized_official_last_name": "MAGBANUA",
        "authorized_official_first_name": "RUSSALETTE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "917-459-3695",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MPS, OTR/L, CHT"
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NY",
            "license": "012509",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "022020",
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NY",
            "license": "010144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2011; 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.