Healthcare Provider Details

I. General information

NPI: 1033031299
Provider Name (Legal Business Name): IMMERSION PT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 VINES RD
BALLSTON LAKE NY
12019-2709
US

IV. Provider business mailing address

51 VINES RD
BALLSTON LAKE NY
12019-2709
US

V. Phone/Fax

Practice location:
  • Phone: 518-275-8394
  • Fax:
Mailing address:
  • Phone: 518-275-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGAN JAMES
Title or Position: OWNER
Credential: PT
Phone: 518-275-8394