Jefferson Sports & Physical Therapy, PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

007458 Issued in NY

Legal business name

JEFFERSON SPORTS & PHYSICAL THERAPY, PC

Practice address

460 County Road 111
#15
Manorville, NY 11949

Phone

(631) 909-8712

Fax

(631) 909-8714

NPI assigned

Jun 16, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Brian Joseph Heim, PTMSNPI 1033168687

Title

Owner/Physical Therapist

Phone

(631) 928-2277

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

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

• Brian J Heim, PT

  • Physical Therapist
  • Port Jefferson, NY
  • NPI 1033168687
  Medicare reassignment Care Compare group NPD Authorized official
• Thomas A Derosa, DPT

  • Physical Therapist
  • Riverhead, NY
  • NPI 1396005518
  Medicare reassignment Care Compare group NPD
• Matthew Heim, DPT

  • Physical Therapist
  • Remsenburg, NY
  • NPI 1760874812
  Medicare reassignment Care Compare group NPD
• Richard Stanley Mallon, DPT

  • Physical Therapist
  • Locust Valley, NY
  • NPI 1821495516
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1407083686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 COUNTY ROAD 111",
            "address_2": "#15",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "11949",
            "telephone_number": "631-909-8712",
            "fax_number": "631-909-8714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 COUNTY ROAD 111",
            "address_2": "#15",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "11949",
            "telephone_number": "631-909-8712",
            "fax_number": "631-909-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON SPORTS & PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-16",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "HEIM",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "631-928-2277",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PTMS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "007458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Independent Group Home Living
• Independent Group Home Living
• Invite Stillness LLC
• Bonnie Jacobs, PHD
• Amy Jakob
• Maryanne Jimenez
• Maria Josephs, PT
• Samantha Justesen
• Cori Lynn Kapopoulos, LCSW
• Denise M Karavas, PA

• Physical Therapist in Manorville, NY
• Providers in Manorville, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.