Katherine Nelson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

055302 Issued in NY

Practice address

792 N Main St Ste 100C
North Syracuse, NY 13212-1667

Phone

(315) 458-2552

Fax

(315) 458-2575

NPI assigned

Dec 12, 2025

Last updated

Dec 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Primary Physical Therapy PLLC

  dba PROActive Physical therapy

  • Physical Therapist
  • North Syracuse, NY
  • NPI 1922071257
  Medicare reassignment NPD
• Primary Physical Therapy PLLC

  dba PROActive Physical Therapy

  • Physical Therapist
  • Cortland, NY
  • NPI 1598088106
  NPD

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

{
    "created_epoch": "1765497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765497600000",
    "number": "1750245841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 N MAIN ST STE 100C",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132121667",
            "telephone_number": "315-458-2552",
            "fax_number": "315-458-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "792 N MAIN ST STE 100C",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132121667",
            "telephone_number": "315-458-2552",
            "fax_number": "315-458-2575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Canalview Mall",
            "address_purpose": "LOCATION",
            "city": "Fulton",
            "state": "NY",
            "postal_code": "130691838",
            "country_code": "US",
            "telephone_number": "315-593-8786",
            "fax_number": "315-595-4032",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "323 Route 5 W",
            "address_purpose": "LOCATION",
            "city": "Weedsport",
            "state": "NY",
            "postal_code": "13166",
            "country_code": "US",
            "telephone_number": "315-689-7989",
            "fax_number": "315-303-6505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "364 Madison St",
            "address_purpose": "LOCATION",
            "city": "Waterville",
            "state": "NY",
            "postal_code": "134801116",
            "country_code": "US",
            "telephone_number": "315-841-3222",
            "fax_number": "315-841-4023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "KATHERINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-12",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "055302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mother Goose Medical Supply, LLC
• Karen G Munson, OPTICIAN
• Jennifer Dina Mutnick, LMSW
• Christine Mylott
• N & N Village Pharmacy Inc (Village Pharmacy)
• Nephrology Hypertension Associates of Cny,P.C.
• New York Anesthesiology Medical Specialties PC (New York Spine and Wellness Center)
• Jaimie W Newman, PA
• Colleen Ney, M.T.
• Stephanie Luu Nguyen, L.AC.

• Physical Therapist in North Syracuse, NY
• Providers in North Syracuse, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.