NPIMap

Organization Active NPI

Professional Occupational & Physical Therapy, PLLC

  • Physical Therapist
  • Port Jefferson, NY
National Provider Identifier
1649631680
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC
Practice address
70 N Country Rd
Port Jefferson, NY 11777-2161
Phone
(631) 331-3608
Fax
(631) 331-2392
NPI assigned
Mar 18, 2016
Last updated
Mar 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Authorized official

Name
Kathleen Brush
Title
Credentialing Manager
Phone
(718) 819-6805

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X

Addresses

Primary practice location

70 N Country Rd
Port Jefferson, NY 11777-2161

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5002
Phone (631) 359-5859

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160608000715 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779873401 Receives reassigned benefits from 513 practitioners
This NPI is an additional NPI on the enrollment
O20180208002131 NY DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 3779873401 Practice locations: Port Jefferson, NY

National Provider Directory

National Provider Directory
Tax ID family
Prof Occptnl Phyl Thpy119 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1649631680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475002",
            "telephone_number": "631-359-5859",
            "fax_number": "631-396-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772161",
            "telephone_number": "631-331-3608",
            "fax_number": "631-331-2392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL OCCUPATIONAL & PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "BRUSH",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "718-819-6805"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.