Active NPI
Susan Ashley Vonvillas, P.T., M.S., D.P.T.
- Pediatric Physical Therapist
- Tomball, TX
National Provider Identifier
1104055375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1171680
- Practice address
- 22702 Newcourt Place Street
Tomball, TX 77375-1125 - Phone
- (281) 546-1228
- Fax
- (832) 761-0308
- NPI assigned
- Jul 9, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1171680 | TX | Primary |
Addresses
Primary practice location
22702 Newcourt Place Street
Tomball, TX 77375-1125
Mailing address
22702 Newcourt Place Street
Tomball, TX 77375-1125
Phone (281) 546-1228
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 283158801 | Medicaid | TX |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1171680 | TX | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quest Pediatric Therapy, Inc. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456099200000",
"number": "1104055375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22702 NEWCOURT PLACE STREET",
"city": "TOMBALL",
"state": "TX",
"postal_code": "773751125",
"telephone_number": "281-546-1228",
"fax_number": "832-761-0308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22702 NEWCOURT PLACE STREET",
"city": "TOMBALL",
"state": "TX",
"postal_code": "773751125",
"telephone_number": "281-546-1228",
"fax_number": "832-761-0308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VONVILLAS",
"first_name": "SUSAN",
"middle_name": "ASHLEY",
"name_prefix": "Ms.",
"credential": "P.T., M.S., D.P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-09",
"last_updated": "2016-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "1171680",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "283158801",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tomball, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.