Alexis Lisa Mack, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2540 Sheridan Dr
Tonawanda, NY 14150-9410

Phone

(716) 862-0567

NPI assigned

May 24, 2021

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Alexis Lisa Peters Former name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sports Physical Therapy of New York, P.C.Group PAC ID 4284531674, 83 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sports Physical Therapy of New York, P.C.

  • Physical Therapist
  • Manlius, NY
  • NPI 1912950072
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1649845454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6965 GOLDFINCH CT",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141201376",
            "telephone_number": "716-548-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 SHERIDAN DR",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141509410",
            "telephone_number": "716-862-0567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6965 Goldfinch Ct",
            "address_purpose": "LOCATION",
            "city": "North Tonawanda",
            "state": "NY",
            "postal_code": "141201376",
            "country_code": "US",
            "telephone_number": "716-548-2930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACK",
        "first_name": "ALEXIS",
        "middle_name": "LISA",
        "name_prefix": "Miss",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-24",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXIS",
            "last_name": "PETERS",
            "middle_name": "LISA",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Marcus Lucas
• Michael Joseph Luero
• Kristen Lynch
• Nicole Ruth Macclellan, MS SPED/ELED
• Macdonald Tyska & Alexander Orthodontics
• John J Maggio, DDS
• Kathleen Mahany
• Abigail Grace Makofske
• Danielle S Mangat, LCSW
• Alexis Marie Manning, OTR/L

• Physical Therapist in Tonawanda, NY
• Providers in Tonawanda, 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 Nov 27, 2023; 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.