NPIMap

Organization Active NPI

Perfect Formation Physical Therapy

Doing business as Perform PT

  • Specialist
  • Hillsborough, NJ
National Provider Identifier
1750480471
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
40QA00926000 Issued in NJ
Legal business name
PERFECT FORMATION PHYSICAL THERAPY
Doing business as
Perform PT
Practice address
411 US Highway 206
Suite 16
Hillsborough, NJ 08844-5024
Phone
(908) 874-4522
Fax
(908) 874-4531
NPI assigned
Sep 21, 2006
Last updated
Oct 14, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

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

Authorized official

Name
Dr. Corinne Marie Sicola, DPTNPI 1225187842
Title
Director / Owner
Phone
(908) 874-4522

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 40QA00926000 NJ Primary

Addresses

Primary practice location

411 US Highway 206
Suite 16
Hillsborough, NJ 08844-5024

Mailing address

411 US Highway 206
Suite 16
Hillsborough, NJ 08844-5024
Phone (908) 874-4522

Other names 1

  • Perform PT Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101207000089 NJ Part B Supplier - Clinic/Group Practice 2668669409 Receives reassigned benefits from 5 practitioners
Practice locations: Hillsborough, NJ

National Provider Directory

National Provider Directory

Locations

411 US Highway 206
Ste 16
Hillsborough, NJ 08844
Phone (908) 794-5029

Practitioners & affiliated clinicians

Practitioners 5

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": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287014400000",
    "number": "1750480471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 US HIGHWAY 206",
            "address_2": "SUITE 16",
            "city": "HILLSBOROUGH",
            "state": "NJ",
            "postal_code": "088445024",
            "telephone_number": "908-874-4522",
            "fax_number": "908-874-4531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 US HIGHWAY 206",
            "address_2": "SUITE 16",
            "city": "HILLSBOROUGH",
            "state": "NJ",
            "postal_code": "088445024",
            "telephone_number": "908-874-4522",
            "fax_number": "908-874-4531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFECT FORMATION PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2010-10-14",
        "status": "A",
        "authorized_official_last_name": "SICOLA",
        "authorized_official_first_name": "CORINNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR / OWNER",
        "authorized_official_telephone_number": "908-874-4522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "40QA00926000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perform PT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hillsborough, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.