Individual provider Active NPI

Laura Holmes

  • Physical Therapist
  • Charlottesville, VA
National Provider Identifier
1861694283
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305202546 Issued in VA
Practice address
1622 Timberwood Blvd Ste 211
Charlottesville, VA 22911
Phone
(434) 202-2830
Fax
(434) 529-8457
NPI assigned
Jun 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2305202546 VA Primary
Physical Therapist 225100000X 020678 NY

Addresses

Primary practice location

1622 Timberwood Blvd Ste 211
Charlottesville, VA 22911

Mailing address

1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200

Other practice location 1

2233 State Route 86
Saranac Lake, NY 12983-5644
Phone (518) 897-2317

Other practice location 2

2233 State Route 86
Saranac Lake, NY 12983-5644
Phone (518) 897-2317

Other identifiers 3

IdentifierTypeStateIssuer
141731786OtherNYHOSPITAL TAX ID #
00363213MedicaidNY
020678OtherNYLICENSE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
020678NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Sept, LLC Physical Therapist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1861694283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 TIMBERWOOD BLVD STE 211",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22911",
            "telephone_number": "434-202-2830",
            "fax_number": "434-529-8457"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2233 State Route 86",
            "address_purpose": "LOCATION",
            "city": "Saranac Lake",
            "state": "NY",
            "postal_code": "129835644",
            "country_code": "US",
            "telephone_number": "518-897-2317",
            "fax_number": "518-897-2423",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2233 State Route 86",
            "address_purpose": "LOCATION",
            "city": "Saranac Lake",
            "state": "NY",
            "postal_code": "129835644",
            "country_code": "US",
            "telephone_number": "518-897-2317",
            "fax_number": "518-897-2423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "LAURA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305202546",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "020678",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL TAX ID #",
            "identifier": "141731786",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00363213",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "020678",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.