St Jude'S Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

028641 Issued in NY

Legal business name

ST JUDE'S PHYSICAL THERAPY

Doing business as

St Jude's Pediatric Services

Practice address

7712 4TH Ave
# 1
Brooklyn, NY 11209-3402

Phone

(646) 224-8040

NPI assigned

Jun 21, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Keisha E John, DPT

Title

Co-President

Phone

(347) 524-0630

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• St Jude's Pediatric Services Doing business as

Tax ID family

St Jude'S Pediatric Services2 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.

• St Judes PT

  • Pediatric Physical Therapist
  • Brooklyn, NY
  • NPI 1205118429
  NPD tax ID

Locations

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322006400000",
    "number": "1982990743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 MACON ST",
            "address_2": "2ND FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162405",
            "telephone_number": "347-524-0630",
            "fax_number": "646-224-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7712 4TH AVE",
            "address_2": "# 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112093402",
            "telephone_number": "646-224-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE'S PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-21",
        "last_updated": "2011-11-23",
        "status": "A",
        "authorized_official_last_name": "JOHN",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CO-PRESIDENT",
        "authorized_official_telephone_number": "347-524-0630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "028641",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NY",
            "license": "016896-1",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "020555-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "A400016264",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03130458",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Jude's Pediatric Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St John'S Episcopal Hospital
• St Johns Dental Care PC
• St Johns Place Pharmacy Inc
• Jean A St Joy
• St Jude Pharmacy & Surgical Supp
• St Judes PT
• Fabie Johanne St Juste, RN
• St Karas Rehab Services Inc
• Carline St Louis, MD
• Maynah St Louis

• Physical Therapist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; 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.