Glenn Austin Petraitis, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

014170-01 Issued in NY

Practice address

800 E Gate Blvd
Garden City, NY 11530-2105

Phone

(831) 849-6000

NPI assigned

Jan 2, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1735776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1881403079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 TONY DR",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117545036",
            "telephone_number": "631-626-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E GATE BLVD",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115302105",
            "telephone_number": "831-849-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRAITIS",
        "first_name": "GLENN",
        "middle_name": "AUSTIN",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-02",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "014170-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert M Peskin, D.D.S.
• Chevanie Peter Cunningham
• Peter E Oneill MD PC
• Marisa Louise Peters, LMSW
• Kirsten E Petersen, MA, CCC-SLP, TSLD,BE
• Nicholas Petrini, PA-C
• Lorraine Elizabeth Petrizzo, MS.ED, BCBA
• Eugene P Pezzollo, D.M.D.
• James Pezzollo, DMD
• Donald Pfeifer, LCSW

• Physical Therapy Assistant in Garden City, NY
• Providers in Garden City, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; 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.