Active NPI
Michael Genovese, MS, PT
- Physical Therapist
- State College, PA
National Provider Identifier
1669649604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT05515L
- Practice address
- 805 S Atherton St
State College, PA 16801-4671 - Phone
- (814) 278-1912
- Fax
- (814) 278-1921
- NPI assigned
- May 9, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT05515L | PA | Primary |
Addresses
Primary practice location
805 S Atherton St
State College, PA 16801-4671
Mailing address
520 Philadelphia St
Indiana, PA 15701-3902
Phone (724) 463-7478
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT05515L | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1669649604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 PHILADELPHIA ST",
"city": "INDIANA",
"state": "PA",
"postal_code": "157013902",
"telephone_number": "724-463-7478",
"fax_number": "724-463-0931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 S ATHERTON ST",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168014671",
"telephone_number": "814-278-1912",
"fax_number": "814-278-1921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENOVESE",
"first_name": "MICHAEL",
"credential": "MS, PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-09",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT05515L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.