FAIRWAY PHYSICAL THERAPY NORTH
NPI 1053503185
Clinic/Center - Physical Therapy in Central Square, NY
About Fairway Physical Therapy North NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FAIRWAY PHYSICAL THERAPY NORTH (NPI 1053503185) is a healthcare organization registered as a physical therapy in Central Square, New York and active in the NPI registry since August 2007. The organization lists Nicole Blythe Derue, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Fairway Physical Therapy North is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Fairway Physical Therapy North, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Nicole Derue Physical Therapy P.C.'s NPI number?
The NPI number for Nicole Derue Physical Therapy P.C. is 1053503185. It was assigned to this organization in the NPPES registry on August 13, 2007. The provider is doing business as Fairway Physical Therapy North.
Where is Nicole Derue Physical Therapy P.C. located?
Nicole Derue Physical Therapy P.C. is located at 573 S Main St, Central Square, NY 13036. The listed phone number is (315) 676-3826.
What is Nicole Derue Physical Therapy P.C.'s specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Physical Therapy, with taxonomy code 261QP2000X.
Is Nicole Derue Physical Therapy P.C. enrolled in Medicare?
Yes. Nicole Derue Physical Therapy P.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Nicole Derue Physical Therapy P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Physical Therapist in Private Practice, reassign their Medicare billing to Nicole Derue Physical Therapy P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Nicole Derue Physical Therapy P.C. was last updated on November 21, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Fairway Physical Therapy North · NPI 1053503185
Physical Therapy organization in Central Square, New York. Organization record, active in the CMS NPPES registry since August 13, 2007.
## Identity
- **NPI:** 1053503185 (Entity type: Organization)
- **Enumerated:** August 13, 2007
- **Primary specialty:** Clinic/Center - Physical Therapy · taxonomy 261QP2000X
- **Legal business name:** Nicole Derue Physical Therapy P.c.
- **Organization subpart:** No
- **Authorized official:** Nicole Derue, PRESIDENT
## Practice location
- **Address:** 573 S MAIN ST, Central Square, NY 13036-9785
- **Phone:** (315) 676-3826 · **Fax:** (315) 676-3402
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Physical Therapist in Private Practice) reassign Medicare billing to this organization (form CMS-855R); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 21, 2007
- **Other identifiers:** Medicare PIN BA1215 (NY)
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Source: [NPI Profile](https://npiprofile.com/npi/1053503185) · Data from the CMS NPPES public registry.