Individual provider Active NPI

Ethan Emmons, DPT

  • Physical Therapist
  • Virginia Beach, VA
National Provider Identifier
1194360180
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305211904 Issued in VA
Practice address
984B Laskin Rd
Virginia Beach, VA 23451-3905
Phone
(757) 395-6900
Fax
(757) 425-7180
NPI assigned
Nov 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X
Physical Therapist 225100000X 2305211904 VA Primary

Addresses

Primary practice location

984B Laskin Rd
Virginia Beach, VA 23451-3905

Mailing address

907 Thousand Oaks Dr
Virginia Beach, VA 23454-3530
Phone (804) 627-2483

Other practice location 1

7419 Granby St
Norfolk, VA 23505-3406
Phone (757) 388-9910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200106000730 VA Practitioner - Physical Therapist in Private Practice 0840624581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentara Therapy Solutions LLCGroup PAC ID 8325370380, 33 clinicians

Practice addresses (Care Compare)

984 B Laskin Rd
Virginia Beach, VA 23451-3905
Phone (757) 395-6900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sentara Therapy Solutions, LLC Physical Therapist CurrentSince Dec 16, 2019 Accepting new patients
Sentara Therapy Solutions, LLC Physical Therapist CurrentSince Dec 16, 2019 Accepting new patients

Locations

984B Laskin Rd
Virginia Beach, VA 23451
Phone (757) 395-6900

Organizations & group practices 2

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": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1194360180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 THOUSAND OAKS DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234543530",
            "telephone_number": "804-627-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984B LASKIN RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234513905",
            "telephone_number": "757-395-6900",
            "fax_number": "757-425-7180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7419 Granby St",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235053406",
            "country_code": "US",
            "telephone_number": "757-388-9910",
            "fax_number": "757-965-8551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EMMONS",
        "first_name": "ETHAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-13",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.