Active NPI
Jeny G Siatkowski, PTA
- Physical Therapy Assistant
- Lake Worth, FL
National Provider Identifier
1780954602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 22652
- Practice address
- 6016 Royal Birkdale Dr
Lake Worth, FL 33463-6523 - Phone
- (561) 601-4997
- NPI assigned
- Jan 9, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 22652 | FL | Primary |
Addresses
Primary practice location
6016 Royal Birkdale Dr
Lake Worth, FL 33463-6523
Mailing address
6016 Royal Birkdale Dr
Lake Worth, FL 33463-6523
Phone (561) 601-4997
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22652 | Other | FL | PTA 22652 |
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 |
|---|---|---|---|
| 22652 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326067200000",
"number": "1780954602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6016 ROYAL BIRKDALE DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334636523",
"telephone_number": "561-601-4997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6016 ROYAL BIRKDALE DR",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334636523",
"telephone_number": "561-601-4997"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIATKOWSKI",
"first_name": "JENY",
"middle_name": "G",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-09",
"last_updated": "2012-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "22652",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA 22652",
"identifier": "22652",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.