Lake Area Physical Therapy Crescent City, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LAKE AREA PHYSICAL THERAPY CRESCENT CITY, INC

Practice address

101 Eucalyptus Ave
Crescent City, FL 32112-2407

Phone

(352) 475-3113

NPI assigned

Sep 15, 2020

Organization subpart

Yes

Parent organization

LAKE AREA PHYSICAL THERAPY INCAs reported in NPPES

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

Authorized official

Name

Ms. Laura HodgesNPI 1649280785

Title

Owner

Phone

(352) 475-3113

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 686985

Legal name

LAKE AREA PHYSICAL THERAPY CRESCENT

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Feb 9, 2021

Last certification

Feb 9, 2021

Ownership / control type

Proprietary

Facility address

101 Eucalyptus Ave
Crescent City, FL 32112

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lake Area Physical Therapy Palatka

  • Physical Therapist
  • Palatka, FL
  • NPI 1841984580

  O20201029000260

  Same enrollment

Tax ID family

Lake Area Physical Therapy Palatka2 organizations share this tax ID, including this one

Part of

Lake Area Physical Ther

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lake Area Physical Therapy Palatka

  • Physical Therapist
  • Palatka, FL
  • NPI 1841984580
  NPD tax ID

Interoperability endpoints

• Direct secure messaging: referrals@lakeareapt.com

Practitioners 2

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

• Laura S Hodges, RPT

  • Physical Therapist
  • Melrose, FL
  • NPI 1649280785
  NPD Authorized official
• Kimberly Sue Bryan, OTR/L

  • Occupational Therapist
  • Crescent City, FL
  • NPI 1558014886
  NPD (past)

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600128000000",
    "number": "1871108910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1099",
            "city": "MELROSE",
            "state": "FL",
            "postal_code": "326661099",
            "telephone_number": "352-475-3113",
            "fax_number": "352-475-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 EUCALYPTUS AVE",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321122407",
            "telephone_number": "352-475-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AREA PHYSICAL THERAPY CRESCENT CITY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE AREA PHYSICAL THERAPY INC",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "HODGES",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-475-3113",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Referrals@LakeAreaPT.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email address",
            "address_1": "101 Eucalyptus Ave",
            "city": "Crescent City",
            "state": "FL",
            "country_code": "US",
            "postal_code": "321122407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joanne Jensen, PHARMD
• John F Hull DO PA
• Charlene Judge, LMT
• Lydia Kite
• Daniel S Kreisman, P.A.
• Lakewood Nursing Center Inc
• Lakewood Operations LLC (Lakewood Nursing and Rehabilitation Center)
• Paul Lee, DMD
• Marcia Marie Long
• Diwata Enriquez Lopez, PT

• Physical Therapist in Crescent City, FL
• Providers in Crescent City, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.