Organization Active NPI

Vibrant Physical Therapy PLLC

  • Physical Therapist
  • Flushing, NY
National Provider Identifier
1902620636
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
VIBRANT PHYSICAL THERAPY PLLC
Practice address
13511 40TH Rd Ste 3a
Flushing, NY 11354-5330
Phone
(646) 417-0641
NPI assigned
Nov 11, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Authorized official

Name
Lynn BarinqueNPI 1922562974
Title
PT
Phone
(646) 417-0641

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

13511 40TH Rd Ste 3a
Flushing, NY 11354-5330

Mailing address

4230 Hampton St Apt 301
Elmhurst, NY 11373-2603
Phone (646) 417-0641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250219001860 NY Part B Supplier - Clinic/Group Practice 9830619907 Receives reassigned benefits from 1 practitioner
Practice locations: Flushing, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1902620636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 HAMPTON ST APT 301",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113732603",
            "telephone_number": "646-417-0641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13511 40TH RD STE 3A",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545330",
            "telephone_number": "646-417-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-10",
        "status": "A",
        "authorized_official_last_name": "BARINQUE",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "646-417-0641"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.