Active NPI
Michael Infantino, DPT
- Physical Therapist
- Draper, UT
National Provider Identifier
1669854188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 048679
- Practice address
- 65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096 - Phone
- (385) 308-8034
- NPI assigned
- Jun 20, 2015
- Last updated
- Jul 20, 2022
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | ||
| Physical Therapist | 225100000X | 25495 | MD | |
| Physical Therapist | 225100000X | PT296163 | CA | |
| Physical Therapist | 225100000X | 048679 | NY | Primary |
Addresses
Primary practice location
65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Mailing address
147 Saybrook Valley Rd
Oak Hill, NY 12460-5105
Phone (518) 821-2455
Other practice location 1
130 Denny Way
El Cajon, CA 92020
Phone (518) 821-2455
Other practice location 2
130 Denny Way
El Cajon, CA 92020
Phone (518) 821-2455
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT296163 | CA | MD | Physical Therapist |
| 25495 | MD | MD | Physical Therapist |
| 048679 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658275200000",
"number": "1669854188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "147 SAYBROOK VALLEY RD",
"city": "OAK HILL",
"state": "NY",
"postal_code": "124605105",
"telephone_number": "518-821-2455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 E WADSWORTH PARK DR STE 230",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208096",
"telephone_number": "385-308-8034"
}
],
"practiceLocations": [
{
"address_1": "130 Denny Way",
"address_purpose": "LOCATION",
"city": "El Cajon",
"state": "CA",
"postal_code": "92020",
"country_code": "US",
"telephone_number": "518-821-2455",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "130 Denny Way",
"address_purpose": "LOCATION",
"city": "El Cajon",
"state": "CA",
"postal_code": "92020",
"country_code": "US",
"telephone_number": "518-821-2455",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "INFANTINO",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-20",
"last_updated": "2022-07-20",
"certification_date": "2022-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "25495",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT296163",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "048679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.