Active NPI
Angela Ninis, PTA
- Physical Therapy Assistant
- Mount Prospect, IL
National Provider Identifier
1174187447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.004914
- Practice address
- 604 W Central Rd
Mount Prospect, IL 60056-2377 - Phone
- (321) 662-1932
- NPI assigned
- Apr 23, 2019
- Last updated
- Apr 23, 2019
- 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 Therapy Assistant | 225200000X | 160.004914 | IL | Primary |
Addresses
Primary practice location
604 W Central Rd
Mount Prospect, IL 60056-2377
Mailing address
604 W Central Rd
Mount Prospect, IL 60056-2377
Phone (321) 662-1932
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200914000279 | IL | Practitioner - Physical Therapist in Private Practice | 9335564111 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.004914 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555977600000",
"number": "1174187447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "604 W CENTRAL RD",
"city": "MOUNT PROSPECT",
"state": "IL",
"postal_code": "600562377",
"telephone_number": "321-662-1932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 W CENTRAL RD",
"city": "MOUNT PROSPECT",
"state": "IL",
"postal_code": "600562377",
"telephone_number": "321-662-1932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NINIS",
"first_name": "ANGELA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-23",
"last_updated": "2019-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.004914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Prospect, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.