Innova Physical Therapy, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

0254361 Issued in NY

Legal business name

INNOVA PHYSICAL THERAPY, PLLC

Practice address

357 Bay Rd
Suite 4
Queensbury, NY 12804-3050

Phone

(518) 632-4944

Fax

(518) 632-4945

NPI assigned

Jan 6, 2015

Organization subpart

No

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

Authorized official

Name

Shannon Regner, PT

Title

Owner

Phone

(518) 632-4944

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• Shannon L O'Hara, PT

  • Physical Therapist
  • Queensbury, NY
  • NPI 1235434721
  Medicare reassignment NPD

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420502400000",
    "number": "1821486481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 BAY RD",
            "address_2": "SUITE 4",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128043050",
            "telephone_number": "518-632-4944",
            "fax_number": "518-632-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 BAY RD",
            "address_2": "SUITE 4",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128043050",
            "telephone_number": "518-632-4944",
            "fax_number": "518-632-4945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVA PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-06",
        "last_updated": "2015-01-06",
        "status": "A",
        "authorized_official_last_name": "REGNER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-632-4944",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "0254361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Hunter, MSW
• Amy Huntington, RDH
• Morgan Louise Hurlburt, LMHC
• Rebecca Hutchison
• Sarah Ignazio, RPH
• Jennifer Islas
• Erik D Istre, MD
• Demi Iverson-Searer
• Vanessa R Ives, LCSW-R
• J. David Bannon MD PC (Bannon Orthopaedics & Sports Medicine)

• Physical Therapy Clinic/Center in Queensbury, NY
• Providers in Queensbury, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; 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.