NPIMap

Organization Active NPI

Grand Island Physical Therapy PC

  • Physical Therapist
  • Grand Island, NY
National Provider Identifier
1902866536
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GRAND ISLAND PHYSICAL THERAPY PC
Practice address
1801 Grand Island Blvd
Grand Island, NY 14072-2171
Phone
(716) 773-4323
Fax
(716) 773-9418
NPI assigned
Mar 27, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Russell A Certo, PHYSICAL THERAPISTNPI 1275502742
Title
Owner
Phone
(716) 773-4323

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Orthopedic Physical Therapist 2251X0800X NU

Addresses

Primary practice location

1801 Grand Island Blvd
Grand Island, NY 14072-2171

Mailing address

1801 Grand Island Blvd
Grand Island, NY 14072-2171
Phone (716) 773-4323

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051118000035 NY Part B Supplier - Clinic/Group Practice 6901825926 Receives reassigned benefits from 30 practitioners
Practice locations: West Seneca, NY; Grand Island, NY; Kenmore, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1902866536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 GRAND ISLAND BLVD",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140722171",
            "telephone_number": "716-773-4323",
            "fax_number": "716-773-9418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 GRAND ISLAND BLVD",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140722171",
            "telephone_number": "716-773-4323",
            "fax_number": "716-773-9418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ISLAND PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CERTO",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-773-4323",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.