NPIMap

Organization Active NPI

Niagara Therapy L.L.C.

  • Rehabilitation Clinic/Center
  • Erie, PA
National Provider Identifier
1760634166
Registry record updated Apr 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
OC006865L Issued in PA
Legal business name
NIAGARA THERAPY L.L.C.
Practice address
2631 W 8TH St
Erie, PA 16505-4034
Phone
(814) 464-0627
Fax
(814) 464-0629
NPI assigned
Oct 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2019

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

Authorized official

Name
Ms. Michelle Lynn Mioduszewski, OTR/LNPI 1689826075
Title
Manager/Member
Phone
(814) 464-0627

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Hearing and Speech Clinic/Center 261QH0700X
Physical Therapy Clinic/Center 261QP2000X
Rehabilitation Clinic/Center 261QR0400X OC006865L PA Primary

Addresses

Primary practice location

2631 W 8TH St
Erie, PA 16505-4034

Mailing address

2631 W 8TH St
Erie, PA 16505-4034
Phone (814) 464-0627

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090806000041 PA Part B Supplier - Clinic/Group Practice 9234282443 Receives reassigned benefits from 21 practitioners
Practice locations: Erie, PA

National Provider Directory

National Provider Directory
Tax ID family
Niagara Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

240 W 11th St
Ste 402
Erie, PA 16501
Phone (814) 464-0627

240 W 11th St
Ste 106
Erie, PA 16501
Phone (814) 464-0627

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554163200000",
    "number": "1760634166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2631 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054034",
            "telephone_number": "814-464-0627",
            "fax_number": "814-464-0629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 W 8TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165054034",
            "telephone_number": "814-464-0627",
            "fax_number": "814-464-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIAGARA THERAPY L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2019-04-02",
        "status": "A",
        "authorized_official_last_name": "MIODUSZEWSKI",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "MANAGER/MEMBER",
        "authorized_official_telephone_number": "814-464-0627",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "PA",
            "license": "OC006865L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; 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.