Active NPI
Fayola O Etienne, DPT
- Physical Therapist
- Washington, DC
National Provider Identifier
1134701766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 25408
- Practice address
- 1145 19TH St NW Ste 403
Washington, DC 20036-3716 - Phone
- (202) 721-7680
- NPI assigned
- Apr 23, 2021
- Sex
- Female
- 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 | 25408 | MA | Primary |
Addresses
Primary practice location
1145 19TH St NW Ste 403
Washington, DC 20036-3716
Mailing address
4 Hart Dr N
South Orange, NJ 07079-1534
Phone (862) 371-8510
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 |
|---|---|---|---|
| 25408 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1134701766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 HART DR N",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "070791534",
"telephone_number": "862-371-8510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 19TH ST NW STE 403",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200363716",
"telephone_number": "202-721-7680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETIENNE",
"first_name": "FAYOLA",
"middle_name": "O",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-23",
"last_updated": "2021-04-23",
"certification_date": "2021-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "25408",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.