NPIMap

Organization Active NPI

Square One Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Pittsburgh, PA
National Provider Identifier
1720438690
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT017595 Issued in PA
Legal business name
SQUARE ONE PHYSICAL THERAPY LLC
Practice address
4543 McKnight Rd
Pittsburgh, PA 15237-3108
Phone
(412) 748-1616
NPI assigned
Jun 21, 2016
Last updated
Apr 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Authorized official

Name
Gordon Riddle, PTNPI 1689620510
Title
Physical Therapist
Phone
(412) 760-4874

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 225400000X
Physical Therapy Clinic/Center 261QP2000X PT017595 PA Primary

Addresses

Primary practice location

4543 McKnight Rd
Pittsburgh, PA 15237-3108

Mailing address

1204 E Elfinwild Rd
Allison Park, PA 15101-3915
Phone (412) 748-1616

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170106001025 PA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6608156500 Receives reassigned benefits from 6 practitioners
Practice locations: Pittsburgh, PA

National Provider Directory

National Provider Directory

Locations

4543 McKnight Rd
Pittsburgh, PA 15237
Phone (412) 748-1616

8623 Old Perry Hwy
Pittsburgh, PA 15237
Phone (412) 748-1616

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1720438690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 E ELFINWILD RD",
            "city": "ALLISON PARK",
            "state": "PA",
            "postal_code": "151013915",
            "telephone_number": "412-748-1616",
            "fax_number": "412-213-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4543 MCKNIGHT RD",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152373108",
            "telephone_number": "412-748-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SQUARE ONE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-21",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "RIDDLE",
        "authorized_official_first_name": "GORDON",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "412-760-4874",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "PA",
            "license": "PT017595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburgh, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.