Organization Active NPI

Summit Physical Therapy LLC

  • Physical Therapist
  • Syracuse, NY
National Provider Identifier
1720082464
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SUMMIT PHYSICAL THERAPY LLC
Practice address
1054 James St
Syracuse, NY 13203-2749
Phone
(315) 422-2912
Fax
(315) 422-3538
NPI assigned
Jun 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Christine Roach, CMA
Title
Billing Dept
Phone
(315) 422-2912

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1054 James St
Syracuse, NY 13203-2749

Mailing address

1054 James St
Syracuse, NY 13203-2749
Phone (315) 422-2912

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040916000178 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294702460 Receives reassigned benefits from 16 practitioners
Practice locations: Manlius, NY; Syracuse, NY; Oswego, NY

National Provider Directory

National Provider Directory

Locations

4136 State Route 31
Clay, NY 13041

103 W Seneca St
Manlius, NY 13104
Phone (315) 682-3387

105 W Seneca St
Manlius, NY 13104
Phone (315) 682-3387

105 W Seneca St
Ste 2
Manlius, NY 13104

91 E 1st St
Oswego, NY 13126
Phone (315) 216-6688

1054 James St
Syracuse, NY 13203
Phone (315) 422-2912

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720082464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032749",
            "telephone_number": "315-422-2912",
            "fax_number": "315-422-3538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032749",
            "telephone_number": "315-422-2912",
            "fax_number": "315-422-3538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "BILLING DEPT",
        "authorized_official_telephone_number": "315-422-2912",
        "authorized_official_credential": "CMA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.