Individual provider Active NPI

Jessica Tabuada, P.T.

  • Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1619306818
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
035609 Issued in NY
Practice address
1084 Liberty Ave
Brooklyn, NY 11208-2923
Phone
(347) 586-0625
Fax
(347) 586-0625
NPI assigned
Nov 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 035609 NY Primary

Addresses

Primary practice location

1084 Liberty Ave
Brooklyn, NY 11208-2923

Mailing address

1084 Liberty Ave
Brooklyn, NY 11208-2923
Phone (347) 586-0625

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140227000061 NY Practitioner - Physical Therapist in Private Practice 5193955789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Home Therapy PT Physical and Occupational Therapy LLCGroup PAC ID 8022268747, 6 clinicians

Practice addresses (Care Compare)

799 Morris Park Ave
Bronx, NY 10462-3604
Phone (718) 684-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
035609NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Home Therapy PT Physical and Occupational Therapy LLC CurrentSince May 7, 2018 Accepting new patients

Locations

817 E 180th St
Bronx, NY 10460
Phone (718) 220-8300

799 Morris Park Ave
Bronx, NY 10462
Phone (718) 684-6300

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1619306818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1084 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082923",
            "telephone_number": "347-586-0625",
            "fax_number": "347-586-0625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1084 LIBERTY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082923",
            "telephone_number": "347-586-0625",
            "fax_number": "347-586-0625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABUADA",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "035609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; 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.