NPIMap

Organization Active NPI

Spry Physical Therapy and Geriatric Wellness, PLLC

  • Physical Therapist
  • Ottawa, IL
National Provider Identifier
1497383673
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPRY PHYSICAL THERAPY AND GERIATRIC WELLNESS, PLLC
Practice address
1028 Lasalle St
Suite B
Ottawa, IL 61350-6135
Phone
(815) 735-2356
NPI assigned
Apr 1, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Authorized official

Name
Lindsey Rae NordstromNPI 1295089399
Title
Owner/Manager of PLLC
Phone
(815) 735-2356

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1028 Lasalle St
Suite B
Ottawa, IL 61350-6135

Mailing address

410 Park Ave
Ottawa, IL 61350-3634
Phone (815) 735-2356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200413002921 IL Part B Supplier - Clinic/Group Practice 3779913884 Receives reassigned benefits from 3 practitioners
Practice locations: Ottawa, IL

National Provider Directory

National Provider Directory

Locations

231 W Madison St
Ottawa, IL 61350
Phone (815) 433-5121

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1497383673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 PARK AVE",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613503634",
            "telephone_number": "815-735-2356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 LASALLE ST",
            "address_2": "SUITE B",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613506135",
            "telephone_number": "815-735-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRY PHYSICAL THERAPY AND GERIATRIC WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-01",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "NORDSTROM",
        "authorized_official_first_name": "LINDSEY",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER/MANAGER OF PLLC",
        "authorized_official_telephone_number": "815-735-2356"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; 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.