Provider Demographics
NPI:1770690356
Name:CERTIFIED PHYSICAL THERAPY ASSOICIATES, PC
Entity Type:Organization
Organization Name:CERTIFIED PHYSICAL THERAPY ASSOICIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHUPPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-676-1445
Mailing Address - Street 1:136 GLENWOOD RD.
Mailing Address - Street 2:PO BOX 274
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-0274
Mailing Address - Country:US
Mailing Address - Phone:516-676-1445
Mailing Address - Fax:516-676-1449
Practice Address - Street 1:136 GLENWOOD RD.
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-0274
Practice Address - Country:US
Practice Address - Phone:516-676-1445
Practice Address - Fax:516-676-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12323225100000X, 2251H1200X
NY10709225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1770690356Medicare NSC
NYQ6W3B1Medicare PIN