NPIMap

Organization Active NPI

Pro Performance Physical Therapy and Wellness, PLLC

  • Orthopedic Physical Therapist
  • Glen Cove, NY
National Provider Identifier
1821262809
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
015585-1 Issued in NY
Legal business name
PRO PERFORMANCE PHYSICAL THERAPY AND WELLNESS, PLLC
Practice address
70 Glen St
Suite 380
Glen Cove, NY 11542-2855
Phone
(516) 277-1153
Fax
(516) 277-1154
NPI assigned
Apr 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Authorized official

Name
Mr. Jonathan A Venegas, PTNPI 1962572552
Title
Member
Phone
(516) 277-1153

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251N0400X 015585-1 NY
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X 015585-1 NY
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X 015585-1 NY Primary

Addresses

Primary practice location

70 Glen St
Suite 380
Glen Cove, NY 11542-2855

Mailing address

70 Glen St
Suite 380
Glen Cove, NY 11542-2855
Phone (516) 277-1153

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080728000503 NY Part B Supplier - Clinic/Group Practice 9830263631 Receives reassigned benefits from 2 practitioners
Practice locations: Glen Cove, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1208736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1821262809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 GLEN ST",
            "address_2": "SUITE 380",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422855",
            "telephone_number": "516-277-1153",
            "fax_number": "516-277-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 GLEN ST",
            "address_2": "SUITE 380",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422855",
            "telephone_number": "516-277-1153",
            "fax_number": "516-277-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO PERFORMANCE PHYSICAL THERAPY AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-21",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "VENEGAS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "516-277-1153",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Neurology",
            "state": "NY",
            "license": "015585-1",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "NY",
            "license": "015585-1",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "015585-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Cove, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; 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.