Individual provider Active NPI

Marissa Ann Drees, DPT

  • Physical Therapist
  • Kingston, NY
National Provider Identifier
1922879451
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
051124 Issued in NY
Practice address
918 Ulster Ave
Kingston, NY 12401-1344
Phone
(845) 802-7080
NPI assigned
Jan 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 051124 NY Primary
Physical Therapist 225100000X SC

Addresses

Primary practice location

918 Ulster Ave
Kingston, NY 12401-1344

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other practice location 1

10879 Clemson Blvd.
Seneca, SC 29678
Phone (864) 482-0085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240213002052 SC Practitioner - Physical Therapist in Private Practice 5799128146 Reassigns benefits to 1 organization
I20240425003699 NY Practitioner - Physical Therapist in Private Practice 5799128146

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
051124NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Jan 25, 2024 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Jan 25, 2024 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

10879 Clemson Blvd
Seneca, SC 29678
Phone (864) 482-0085

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1922879451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 ULSTER AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124011344",
            "telephone_number": "845-802-7080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10879 Clemson Blvd.",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "SC",
            "postal_code": "29678",
            "country_code": "US",
            "telephone_number": "864-482-0085",
            "fax_number": "864-482-0072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DREES",
        "first_name": "MARISSA",
        "middle_name": "ANN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "051124",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.