Active NPI
Lise Petricone, PT
- Pediatric Physical Therapist
- Nyack, NY
National Provider Identifier
1760635668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 009027-1
- Practice address
- 21 Burd St
Nyack, NY 10960-3205 - Phone
- (845) 353-2350
- Fax
- (845) 353-2397
- NPI assigned
- Oct 23, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 009027-1 | NY | Primary |
Addresses
Primary practice location
21 Burd St
Nyack, NY 10960-3205
Mailing address
21 Burd St
Nyack, NY 10960-3205
Phone (845) 353-2350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009027-1 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lise Petricone Inc. Dba Small Steps | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Early Intervention Provider Agency
- Nyack, NY
- NPI 1639321730
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310947200000",
"number": "1760635668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 BURD ST",
"city": "NYACK",
"state": "NY",
"postal_code": "109603205",
"telephone_number": "845-353-2350",
"fax_number": "845-353-2397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 BURD ST",
"city": "NYACK",
"state": "NY",
"postal_code": "109603205",
"telephone_number": "845-353-2350",
"fax_number": "845-353-2397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRICONE",
"first_name": "LISE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-23",
"last_updated": "2011-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NY",
"license": "009027-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nyack, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.