Active NPI
Photina Faye Penn, PHYSICAL THERAPIST
- Physical Therapist
- Coram, NY
National Provider Identifier
1861661803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 005546-1
- Practice address
- 31 Wintergreen Dr
Coram, NY 11727-2222 - Phone
- (631) 331-1780
- NPI assigned
- Feb 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 005546-1 | NY | Primary |
Addresses
Primary practice location
31 Wintergreen Dr
Coram, NY 11727-2222
Mailing address
31 Wintergreen Dr
Coram, NY 11727-2222
Phone (631) 331-1780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005546-1 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1861661803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 WINTERGREEN DR",
"city": "CORAM",
"state": "NY",
"postal_code": "117272222",
"telephone_number": "631-331-1780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 WINTERGREEN DR",
"city": "CORAM",
"state": "NY",
"postal_code": "117272222",
"telephone_number": "631-331-1780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "PHOTINA",
"middle_name": "FAYE",
"name_prefix": "Mrs.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-25",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "005546-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coram, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.