Positive Performance Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

POSITIVE PERFORMANCE PHYSICAL THERAPY LLC

Practice address

1146 Karen St
Boalsburg, PA 16827-1642

Phone

(814) 441-9183

Fax

(833) 277-6195

NPI assigned

Dec 30, 2022

Organization subpart

No

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

Authorized official

Name

Traci Richardson, DPTNPI 1972504769

Title

Sole MBR

Phone

(814) 441-9183

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Traci Richardson, DPT Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

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

• Traci L Richardson, DPT

  • Physical Therapist
  • Boalsburg, PA
  • NPI 1972504769
  Medicare reassignment Authorized official
• Lisa Koslicki, DPT

  • Physical Therapist
  • State College, PA
  • NPI 1578016234
  Medicare reassignment

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

{
    "created_epoch": "1672358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1619680105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "BOALSBURG",
            "state": "PA",
            "postal_code": "168270218",
            "telephone_number": "814-441-9183",
            "fax_number": "833-277-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1146 KAREN ST",
            "city": "BOALSBURG",
            "state": "PA",
            "postal_code": "168271642",
            "telephone_number": "814-441-9183",
            "fax_number": "833-277-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POSITIVE PERFORMANCE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-30",
        "last_updated": "2022-12-30",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "814-441-9183",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101115561-0005",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "positiveperformance@trichardsondpt.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1146 Karen St",
            "city": "Boalsburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "168271642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Traci Richardson, DPT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Ann Kellogg, LPN, LAT, ATC
• Made to Move Physical Therapy
• Maeve Leonia McFeely
• Olive Tree Counseling
• Nicole Pautz
• Linda K Puder, LMT
• Andrea Lynn Reed, RDN
• Traci L Richardson, DPT
• Schmidt Chiropractic
• Sharon A Schott, LPC, CRC

• Physical Therapy Clinic/Center in Boalsburg, PA
• Providers in Boalsburg, PA by specialty
• Physical Therapy Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.