NPIMap

Organization Active NPI

Creekside Physical Therapy PC

  • Physical Therapy Clinic/Center
  • Collins, NY
National Provider Identifier
1891989661
Registry record updated May 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
008212 Issued in NY
Legal business name
CREEKSIDE PHYSICAL THERAPY PC
Practice address
14318 Route 62
Collins, NY 14034-9788
Phone
(716) 532-8129
Fax
(716) 532-9201
NPI assigned
Sep 5, 2007
Last updated
May 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2008

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

Authorized official

Name
Mrs. Ellen Beth Wilson, P.T.NPI 1487615522
Title
President
Phone
(716) 532-8129

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 008212 NY Primary

Addresses

Primary practice location

14318 Route 62
Collins, NY 14034-9788

Mailing address

14318 Route 62
Collins, NY 14034-9788
Phone (716) 532-8129

Other identifiers 4

IdentifierTypeStateIssuer
000623245003OtherNYBLUE CROSS/BLUE SHIELD OF
822231OtherNYEMPIRE
00010244901OtherNYUNIVERA
9308583OtherNYINDEPENDENT HEALTH

National Provider Directory

National Provider Directory

Locations

14318 Route 62
Collins, NY 14034
Phone (716) 532-8129

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1891989661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14318 ROUTE 62",
            "city": "COLLINS",
            "state": "NY",
            "postal_code": "140349788",
            "telephone_number": "716-532-8129",
            "fax_number": "716-532-9201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14318 ROUTE 62",
            "city": "COLLINS",
            "state": "NY",
            "postal_code": "140349788",
            "telephone_number": "716-532-8129",
            "fax_number": "716-532-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "716-532-8129",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "008212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD OF",
            "identifier": "000623245003",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE",
            "identifier": "822231",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010244901",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "9308583",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Collins, NY

Sources for this page

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

Verify at the official NPI Registry.