NPIMap

Organization Active NPI

West Schuylkill Physical Therapy Services, P.C.

  • Physical Therapist
  • Pine Grove, PA
National Provider Identifier
1972528024
Registry record updated Apr 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
WEST SCHUYLKILL PHYSICAL THERAPY SERVICES, P.C.
Practice address
8 Oak Grove Rd
Suite 3
Pine Grove, PA 17963
Phone
(570) 345-9966
Fax
(570) 345-9988
NPI assigned
Jul 12, 2006
Last updated
Apr 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2008

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

Authorized official

Name
Mrs. Kelly C Putalavage
Title
Office Manager
Phone
(570) 345-9966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

8 Oak Grove Rd
Suite 3
Pine Grove, PA 17963

Mailing address

8 Oak Grove Rd
Suite 3
Pine Grove, PA 17963
Phone (570) 345-9966

Other identifiers 4

IdentifierTypeStateIssuer
02858300OtherPACAPITAL BLUE CROSS/CAIC
720544OtherPAPENNSYLVANIA BLUE SHIELD
02858300OtherPACAPITAL ADVANTAGE
033989OtherPAHIGHMARK MEDICARE SERVICES

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314000871 PA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6709771744 Receives reassigned benefits from 4 practitioners
Practice locations: Pine Grove, PA

National Provider Directory

National Provider Directory

Locations

8 Oak Grove Rd
Ste 3
Pine Grove, PA 17963
Phone (570) 345-9966

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1972528024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 OAK GROVE RD",
            "address_2": "SUITE 3",
            "city": "PINE GROVE",
            "state": "PA",
            "postal_code": "17963",
            "telephone_number": "570-345-9966",
            "fax_number": "570-345-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 OAK GROVE RD",
            "address_2": "SUITE 3",
            "city": "PINE GROVE",
            "state": "PA",
            "postal_code": "17963",
            "telephone_number": "570-345-9966",
            "fax_number": "570-345-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SCHUYLKILL PHYSICAL THERAPY SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "PUTALAVAGE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "570-345-9966",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS/CAIC",
            "identifier": "02858300",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA BLUE SHIELD",
            "identifier": "720544",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL ADVANTAGE",
            "identifier": "02858300",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK MEDICARE SERVICES",
            "identifier": "033989",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Grove, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; 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.