Active NPI
Matthew Civitello, MPT
- Pediatric Physical Therapist
- Orlando, FL
National Provider Identifier
1154895233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT27455
- Practice address
- 13535 Nemours Pkwy
Orlando, FL 32827-7402 - Phone
- (407) 650-4000
- NPI assigned
- Jan 11, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PT27455 | FL | Primary |
Addresses
Primary practice location
13535 Nemours Pkwy
Orlando, FL 32827-7402
Mailing address
10140 Centurion Pkwy N
Jacksonville, FL 32256-0532
Phone (904) 697-4000
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 |
|---|---|---|---|
| PT27455 | FL | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547164800000",
"number": "1154895233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10140 CENTURION PKWY N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322560532",
"telephone_number": "904-697-4000",
"fax_number": "904-697-5102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13535 NEMOURS PKWY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328277402",
"telephone_number": "407-650-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVITELLO",
"first_name": "MATTHEW",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-11",
"last_updated": "2019-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "FL",
"license": "PT27455",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.