Jesse Phalanukorn

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61209291 Issued in WA

Practice address

489 Brick Blvd
Brick, NJ 08723-6055

Phone

(732) 895-7283

NPI assigned

Oct 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, AK2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Denali Physical Therapy Limited PartnershipGroup PAC ID 6507958501, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Denali Physical Therapy Limited Partnership

  • Physical Therapist
  • Anchorage, AK
  • NPI 1558568766
  Medicare reassignment Care Compare group NPD
• Atlantic Physical Therapy Center

  • Orthopedic Physical Therapist
  • Toms River, NJ
  • NPI 1801857917
  Medicare reassignment NPD
• Atlantic Physical Therapy Center

  • Hand Occupational Therapist
  • Oakhurst, NJ
  • NPI 1659945228
  NPD

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1407455199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 BRICK BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087236055",
            "telephone_number": "732-895-7283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 BRICK BLVD",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087236055",
            "telephone_number": "732-895-7283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHALANUKORN",
        "first_name": "JESSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-22",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61209291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter E. Lowenstein DC PA
• Gretchen Lynn Peters, MSN, APRN, FNP-C
• John Petrocco III, M.S.W., L.C.S.W.
• Oleksandra Petryna, MD
• Rebecca Leigh Pfeffer, PHARMD, BCACP
• Physician Management Services of New Jersey II, LLC
• Physicians Dialysis Brick LLC
• Nicole Piasentini
• Lisa Picciotto, SLP-CCC
• Danielle Nicole Pickard, LCSW

• Physical Therapist in Brick, NJ
• Providers in Brick, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.