NPIMap

Individual provider Active NPI

Lynn Marie Distasio, LPT

  • Physical Therapist
  • Plains, PA
National Provider Identifier
1821164393
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT006913L Issued in PA
Practice address
1086 Route 315
Plains, PA 18702
Phone
(570) 823-7761
Fax
(570) 822-8033
NPI assigned
Nov 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT006913L PA Primary

Addresses

Primary practice location

1086 Route 315
Plains, PA 18702

Mailing address

1086 Route 315
Pro Rehabilitation Services
Plains, PA 18702
Phone (570) 823-7761

Other identifiers 7

IdentifierTypeStateIssuer
076541OtherFIRST PRIORITY
0661771OtherBLUE SHIELD
442518OtherHEALTH AMERICA ASSURANCE
442539OtherHEALTH AMERICA ASSURANCE
815826OtherFIRST PRIORITY
813831OtherFIRST PRIORITY
397908OtherHEALTH AMERICA ASSURANCE

Other names 1

  • Lynn Marie Butczynski Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231208000221 PA Practitioner - Physical Therapist in Private Practice 6204910649 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT006913LPAMDPhysical Therapist

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821164393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 ROUTE 315",
            "address_2": "PRO REHABILITATION SERVICES",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "18702",
            "telephone_number": "570-823-7761",
            "fax_number": "570-822-8033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1086 ROUTE 315",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "18702",
            "telephone_number": "570-823-7761",
            "fax_number": "570-822-8033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTASIO",
        "first_name": "LYNN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT006913L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "076541",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0661771",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA ASSURANCE",
            "identifier": "442518",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA ASSURANCE",
            "identifier": "442539",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "815826",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "813831",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA ASSURANCE",
            "identifier": "397908",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYNN",
            "last_name": "BUTCZYNSKI",
            "middle_name": "MARIE",
            "credential": "LPT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Plains, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.