NPIMap

Organization Active NPI

South Jefferson Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Adams, NY
National Provider Identifier
1407930829
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SOUTH JEFFERSON PHYSICAL THERAPY PC
Practice address
70 N Main St
Adams, NY 13605-3102
Phone
(315) 232-2225
Fax
(315) 232-2800
NPI assigned
Oct 24, 2006
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Heather Ann Miller, DPTNPI 1922199116
Title
Owner
Phone
(315) 232-2225

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
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

70 N Main St
Adams, NY 13605-3102

Mailing address

70 N Main St
Adams, NY 13605-3102
Phone (315) 232-2225

Other practice location 1

307 Riverside Dr
Clayton, NY 13624-1022
Phone (315) 285-5159

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000029 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8224205604 Receives reassigned benefits from 4 practitioners
Practice locations: Adams, NY; Clayton, NY

National Provider Directory

National Provider Directory

Locations

10924 US Route 11
Ste 7
Adams, NY 13605
Phone (315) 232-2225

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1407930829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 N MAIN ST",
            "city": "ADAMS",
            "state": "NY",
            "postal_code": "136053102",
            "telephone_number": "315-232-2225",
            "fax_number": "315-232-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 N MAIN ST",
            "city": "ADAMS",
            "state": "NY",
            "postal_code": "136053102",
            "telephone_number": "315-232-2225",
            "fax_number": "315-232-2800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "307 Riverside Dr",
            "address_purpose": "LOCATION",
            "city": "Clayton",
            "state": "NY",
            "postal_code": "136241022",
            "country_code": "US",
            "telephone_number": "315-285-5159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH JEFFERSON PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-232-2225",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adams, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.