Craig Clarke Ullock, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

017728 Issued in NY

Practice address

66 Stanley St
Mount Morris, NY 14510-1435

Phone

(585) 658-9280

NPI assigned

Jan 15, 2007

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 NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1997

Medicare assignment

May accept Medicare assignment

Group practices

Physical Therapy Professionals, PCGroup PAC ID 1153486485, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Physical Therapy Professionals, PC

  • Physical Therapist
  • Lakeville, NY
  • NPI 1083834758
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1528119633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3506 THOMAS DRIVE",
            "city": "LAKEVILLE",
            "state": "NY",
            "postal_code": "14480",
            "telephone_number": "585-346-0060",
            "fax_number": "585-346-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 STANLEY ST",
            "city": "MOUNT MORRIS",
            "state": "NY",
            "postal_code": "145101435",
            "telephone_number": "585-658-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLOCK",
        "first_name": "CRAIG",
        "middle_name": "CLARKE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "017728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Tebeau, P.T.
• Carol Thompson, RN
• Carol M Thompson, RN
• Autumn Timothy
• Town of Mt. Morris
• Kelly Utley, RN
• Amanda Wachter
• Walgreen Co
• Donna Marie Walsworth, RN, BSN
• Sarah Marie Warner

• Physical Therapist in Mount Morris, NY
• Providers in Mount Morris, 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 Jun 20, 2018; 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.