Wirth Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

WIRTH PHYSICAL THERAPY PC

Practice address

650 Hawkins Ave Ste 4
Lake Ronkonkoma, NY 11779-2366

Phone

(631) 981-7422

Fax

(631) 981-2490

NPI assigned

May 20, 2019

Organization subpart

No

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

Authorized official

Name

Michael WirthNPI 1306180583

Title

Owner

Phone

(631) 981-7422

Specialties & licenses 1

Addresses

Other names 1

• Pinnacle Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

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

• Michael Wirth, DPT

  • Physical Therapist
  • Lake Ronkonkoma, NY
  • NPI 1306180583
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558310400000",
    "number": "1851958490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 HAWKINS AVE STE 4",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792366",
            "telephone_number": "631-981-7422",
            "fax_number": "631-981-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HAWKINS AVE STE 4",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792366",
            "telephone_number": "631-981-7422",
            "fax_number": "631-981-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIRTH PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-20",
        "last_updated": "2019-05-20",
        "status": "A",
        "authorized_official_last_name": "WIRTH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-981-7422"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinnacle Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittney Lyn Weitz
• Dawn Marie Wigutow
• Jennifer Grace Wiley
• Maureen Wilmott, RN
• Eileen Wilson
• Michael Wirth, DPT
• Kimberlie A Wottawa, LMSW
• Michelle L Young

• Physical Therapist in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, 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 May 20, 2019; 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.