Active NPI
Alice Nellenbach, PTA
- Physical Therapy Assistant
- Liverpool, NY
National Provider Identifier
1609350016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 29425
- Practice address
- 346 Electronics Pkwy
Liverpool, NY 13088 - Phone
- (315) 404-3093
- NPI assigned
- Sep 20, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 006972-1 | NY | |
| Physical Therapy Assistant | 225200000X | 29425 | FL | Primary |
Addresses
Primary practice location
346 Electronics Pkwy
Liverpool, NY 13088
Mailing address
351 Orange Blossom Drive
Winter Haven, FL 33880
Phone (315) 404-3093
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006972-1 | NY | MD | Occupational Therapy Assistant |
| 29425 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580256000000",
"number": "1609350016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 ORANGE BLOSSOM DRIVE",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "33880",
"telephone_number": "315-404-3093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "346 ELECTRONICS PKWY",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "13088",
"telephone_number": "315-404-3093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELLENBACH",
"first_name": "ALICE",
"name_prefix": "Ms.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-20",
"last_updated": "2020-01-29",
"certification_date": "2020-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "006972-1",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "29425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.