NPIMap

Organization Active NPI

Primary Physical Therapy PLLC

  • Physical Therapist
  • North Syracuse, NY
National Provider Identifier
1922071257
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRIMARY PHYSICAL THERAPY PLLC
Practice address
792 N Main St
Suite 100C
North Syracuse, NY 13212-1644
Phone
(315) 458-2552
Fax
(315) 458-2575
NPI assigned
Feb 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
Michelle L Stearns
Title
VP Admin
Phone
(315) 458-2552

Specialties & licenses 1

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

Addresses

Primary practice location

792 N Main St
Suite 100C
North Syracuse, NY 13212-1644

Mailing address

792 N Main St
Suite 100C
North Syracuse, NY 13212-1644
Phone (315) 458-2552

Other practice location 1

364 Madison St
Waterville, NY 13480-1116
Phone (315) 841-3222

Other practice location 2

140 W Seneca St
Manlius, NY 13104-2420
Phone (315) 692-2336

Other identifiers 1

IdentifierTypeStateIssuer
0000025332OtherNYBCBS CNY

Other names 1

  • PROActive Physical therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031216000366 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9335046598 Receives reassigned benefits from 12 practitioners
Practice locations: Fulton, NY; Weedsport, NY; North Syracuse, NY; Waterville, NY

National Provider Directory

National Provider Directory
Tax ID family
Primary Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10 Canalview Mall
Ste C
Fulton, NY 13069
Phone (315) 593-8786

364 Madison St
Waterville, NY 13480
Phone (315) 841-3222

323 State Route 5
Ste 5
Weedsport, NY 13166
Phone (315) 689-7989

323 State Route 5
#5
Weedsport, NY 13166

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1922071257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "792 N MAIN ST",
            "address_2": "SUITE 100C",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132121644",
            "telephone_number": "315-458-2552",
            "fax_number": "315-458-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "792 N MAIN ST",
            "address_2": "SUITE 100C",
            "city": "NORTH SYRACUSE",
            "state": "NY",
            "postal_code": "132121644",
            "telephone_number": "315-458-2552",
            "fax_number": "315-458-2575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "364 Madison St",
            "address_purpose": "LOCATION",
            "city": "Waterville",
            "state": "NY",
            "postal_code": "134801116",
            "country_code": "US",
            "telephone_number": "315-841-3222",
            "fax_number": "315-841-4023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "140 W Seneca St",
            "address_purpose": "LOCATION",
            "city": "Manlius",
            "state": "NY",
            "postal_code": "131042420",
            "country_code": "US",
            "telephone_number": "315-692-2336",
            "fax_number": "315-692-2337",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMARY PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A",
        "authorized_official_last_name": "STEARNS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP ADMIN",
        "authorized_official_telephone_number": "315-458-2552"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CNY",
            "identifier": "0000025332",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROActive Physical therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.