Individual provider Active NPI

Chiye Onodera Duffy, MPT, C/NDT, CIMI

  • Pediatric Physical Therapist
  • Port Orange, FL
National Provider Identifier
1912280447
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
PT 29683 Issued in FL
Practice address
900 N Swallow Tail Dr Ste 107
Port Orange, FL 32129-6103
Phone
(386) 446-9935
Fax
(386) 446-7777
NPI assigned
Sep 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X PT 20885 CA
Pediatric Physical Therapist 2251P0200X PT 29683 FL Primary

Addresses

Primary practice location

900 N Swallow Tail Dr Ste 107
Port Orange, FL 32129-6103

Mailing address

5558 W. Bayshore Drive
Port Orange, FL 32127-6116
Phone (949) 256-6918

Other practice location 1

809 S Duss St
New Smyrna Beach, FL 32168-7531
Phone (386) 416-9869

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

LicenseStateTypeSpecialty
PT 20885CAMDPediatric Physical Therapist
PT 29683FLMDPediatric Physical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1912280447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5558 W. BAYSHORE DRIVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321276116",
            "telephone_number": "949-256-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N SWALLOW TAIL DR STE 107",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321296103",
            "telephone_number": "386-446-9935",
            "fax_number": "386-446-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 S Duss St",
            "address_purpose": "LOCATION",
            "city": "New Smyrna Beach",
            "state": "FL",
            "postal_code": "321687531",
            "country_code": "US",
            "telephone_number": "386-416-9869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUFFY",
        "first_name": "CHIYE",
        "middle_name": "ONODERA",
        "name_prefix": "Mrs.",
        "credential": "MPT, C/NDT, CIMI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-21",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT 20885",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "FL",
            "license": "PT 29683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.