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General NPI Number Information
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NPI Number | 1033031299
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Entity Type | Organization
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Legal Business Name | IMMERSION PT PLLC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 51 VINES RD
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-2709
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Country | US
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Telephone | 518-275-8394
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Fax |
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Provider Business Mailing Address
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Address Line | 51 VINES RD
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City | BALLSTON LAKE
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State | NY
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Zip | 12019-2709
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Country | US
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Telephone | 518-275-8394
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN JAMES
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Credential | PT
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Telephone | 518-275-8394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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