Lake Champlain Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

030350-1 Issued in NY

Legal business name

LAKE CHAMPLAIN PHYSICAL THERAPY PLLC

Practice address

2786 Main St
Crown Point, NY 12928

Phone

(518) 597-3384

NPI assigned

Mar 16, 2015

Last updated

Mar 16, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Leonardo S Lopes-Gomes, P.T.NPI 1609037084

Title

Owner/Physical Therapist

Phone

(518) 597-3384

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, and the practitioner matching its NPPES authorized official.

• Leonardo Lopes-Gomes, PT

  • Physical Therapist
  • Crown Point, NY
  • NPI 1609037084
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426464000000",
    "number": "1841683869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2786MAIN STREET",
            "city": "CROWN POINT",
            "state": "NY",
            "postal_code": "12928",
            "telephone_number": "518-597-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2786 MAIN ST",
            "city": "CROWN POINT",
            "state": "NY",
            "postal_code": "12928",
            "telephone_number": "518-597-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CHAMPLAIN PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-16",
        "last_updated": "2015-03-16",
        "status": "A",
        "authorized_official_last_name": "LOPES-GOMES",
        "authorized_official_first_name": "LEONARDO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "518-597-3384",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "030350-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adirondack Osteopathy PLLC
• Colonette Jane Burleigh, P.T.
• Crown Point Central School
• Darlene Ann Hughes I
• Kirana Lynn Lavallie, NP
• Leonardo Lopes-Gomes, PT
• Timothy Robert Lyman, MA, LADC
• Peter Mayo Sayers, MD
• Tukk Simpson

• Physical Therapist in Crown Point, NY
• Providers in Crown Point, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.