NPIMap

Organization Active NPI

Professional Orthopedic and Sports Physical Therapy, PC

  • Physical Therapist
  • Queens Village, NY
National Provider Identifier
1689233181
Registry record updated Jun 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, PC
Practice address
22005 Hillside Ave
C/O Blink
Queens Village, NY 11427-2033
Phone
(718) 400-8330
Fax
(718) 400-8340
NPI assigned
Jun 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2019

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
(631) 359-5805

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

22005 Hillside Ave
C/O Blink
Queens Village, NY 11427-2033

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Professional Orthopedic and Sports Physical Therapy PC15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1559952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559952000000",
    "number": "1689233181",
    "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": "22005 HILLSIDE AVE",
            "address_2": "C/O BLINK",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114272033",
            "telephone_number": "718-400-8330",
            "fax_number": "718-400-8340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-08",
        "last_updated": "2019-06-08",
        "status": "A",
        "authorized_official_last_name": "BRUSH",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "631-359-5805"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queens Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.