Active NPI
Kristine A. Cervantes, LPT
- Physical Therapist
- Syracuse, NY
National Provider Identifier
1871647636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 030277
- Practice address
- 2949 Erie Blvd E
Syracuse, NY 13224-1442 - Phone
- (315) 251-1036
- NPI assigned
- Jan 22, 2007
- Last updated
- Oct 1, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 030277 | NY | Primary |
| Physical Therapist | 225100000X | 9026 | NC |
Addresses
Primary practice location
2949 Erie Blvd E
Syracuse, NY 13224-1442
Mailing address
7960 Joss Farm Way
Cicero, NY 13039
Phone (910) 584-8571
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7211438 | Medicaid | NC | |
| 7211258 | Other | NC | MEDICAID GROUP PROV. # |
| 013X1 | Other | NC | BCBS GROUP PROV. # |
| 079FC | Other | NC | BCBS INDIV PROVIDER # |
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 |
|---|---|---|---|
| 9026 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222819200000",
"number": "1871647636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7960 JOSS FARM WAY",
"city": "CICERO",
"state": "NY",
"postal_code": "13039",
"telephone_number": "910-584-8571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2949 ERIE BLVD E",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132241442",
"telephone_number": "315-251-1036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERVANTES",
"first_name": "KRISTINE",
"middle_name": "A.",
"name_prefix": "Mrs.",
"credential": "LPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2008-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "030277",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "9026",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7211438",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID GROUP PROV. #",
"identifier": "7211258",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP PROV. #",
"identifier": "013X1",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIV PROVIDER #",
"identifier": "079FC",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.