Palm Harbor Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT4811 Issued in FL

Legal business name

PALM HARBOR PHYSICAL THERAPY

Practice address

30522 US Highway 19 N
Suite 110
Palm Harbor, FL 34684-4444

Phone

(727) 789-6008

Fax

(727) 789-0716

NPI assigned

Jul 21, 2005

Last updated

Mar 20, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Andrew N Loscalzo, PT, DPT, ATCNPI 1386777670

Title

Administrator

Phone

(727) 789-6008

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417957358. Details of each certification follow.

• CCN 106801 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 106801

Legal name

PALM HARBOR PHYSICAL THERAPY

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Nov 3, 1992

Last certification

Jul 9, 2014

Ownership / control type

Proprietary

Facility address

30522 US Hwy 19 N
Palm Harbor, FL 34684

Locations

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.

• Andrew N Loscalzo, PT, DPT, ATC

  • Physical Therapist
  • Palm Harbor, FL
  • NPI 1386777670
  NPD (past) Authorized official
• Robert J Mortillaro, PTA

  • Physical Therapy Assistant
  • Palm Harbor, FL
  • NPI 1972709905
  NPD (past)
• Beth T Pike, PTA

  • Physical Therapy Assistant
  • Palm Harbor, FL
  • NPI 1184820102
  NPD (past)
• Keith Bradley Stark, PT, DPT

  • Physical Therapist
  • Palm Harbor, FL
  • NPI 1265565907
  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1417957358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30522 US HIGHWAY 19 N",
            "address_2": "SUITE 110",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346844444",
            "telephone_number": "727-789-6008",
            "fax_number": "727-789-0716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30522 US HIGHWAY 19 N",
            "address_2": "SUITE 110",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346844444",
            "telephone_number": "727-789-6008",
            "fax_number": "727-789-0716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM HARBOR PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "LOSCALZO",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-789-6008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT4811",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA2119",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "882119400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROV# - NPR OFFICE",
            "identifier": "RA4",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B/C B/S PROV# - PH OFFICE",
            "identifier": "R3L",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.