Active NPI
Jose Angelo Gracia Niedo, PT
- Physical Therapist
- Philadelphia, PA
National Provider Identifier
1033856869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT030094
- Practice address
- 3300 Grant Ave Ste 20
Philadelphia, PA 19114-2632 - Phone
- (877) 444-2422
- NPI assigned
- May 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT030094 | PA | Primary |
Addresses
Primary practice location
3300 Grant Ave Ste 20
Philadelphia, PA 19114-2632
Mailing address
1003 Easton Rd Apt 914C
Willow Grove, PA 19090-2068
Phone (575) 214-1588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT030094 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652400000000",
"number": "1033856869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 EASTON RD APT 914C",
"city": "WILLOW GROVE",
"state": "PA",
"postal_code": "190902068",
"telephone_number": "575-214-1588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 GRANT AVE STE 20",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191142632",
"telephone_number": "877-444-2422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEDO",
"first_name": "JOSE ANGELO",
"middle_name": "GRACIA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-13",
"last_updated": "2022-05-13",
"certification_date": "2022-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT030094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.