Anthony Jacaruso
Individual provider Active NPI Physical Therapist · Gray, TN
NPI 1124394770 · NPPES record last updated Mar 13, 2024
Key facts
- NPI
- 1124394770
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 14601 (TN)
- Practice address
- 406 Roy Martin Rd Ste 9
Gray, TN 37615-2245 - Phone
- (423) 477-1101
- NPI assigned
- Mar 28, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Achieve Health and Wellness
Practice addresses (Care Compare)
406 Roy Martin Rd
Suite 9
Gray, TN 37615-2245
Phone (423) 477-1101
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241210002758 | TN | Practitioner - Physical Therapist in Private Practice | 2961938246 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018884-1 | NY | MD | Physical Therapist |
| 14601 | TN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Achieve Health and Wellness | Physical Therapist | Current |
Accepting new patients |
| Achieve Health and Wellness | Past |
Accepting new patients |
Locations
406 Roy Martin Rd
Ste 9
Johnson City, TN 37615
Phone (423) 477-1101
110 E Center St
Kingsport, TN 37660
Phone (423) 477-1101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 018884-1 | NY | |
| Physical Therapist | 225100000X | 14601 | TN | Yes |
Addresses
Primary practice location
406 Roy Martin Rd Ste 9
Gray, TN 37615-2245
Mailing address
296 Jessicas Way
Johnson City, TN 37615-3079
Phone (917) 853-9763
Other providers in Gray, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.