Active NPI
Rex Dacillo
- Physical Therapy Assistant
- Lawrenceville, NJ
National Provider Identifier
1205018256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- TEI002499
- Practice address
- 42 Hawk Rd
Lawrenceville, NJ 08648-1353 - Phone
- (609) 919-1930
- NPI assigned
- Dec 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA40QB00242200 | NJ | |
| Physical Therapy Assistant | 225200000X | TEI002499 | PA | Primary |
Addresses
Primary practice location
42 Hawk Rd
Lawrenceville, NJ 08648-1353
Mailing address
42 Hawk Rd
Lawrenceville, NJ 08648-1353
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 |
|---|---|---|---|
| PTA40QB00242200 | NJ | MD | Physical Therapy Assistant |
| TEI002499 | PA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407024000000",
"number": "1205018256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 HAWK RD",
"city": "LAWRENCEVILLE",
"state": "NJ",
"postal_code": "086481353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 HAWK RD",
"city": "LAWRENCEVILLE",
"state": "NJ",
"postal_code": "086481353",
"telephone_number": "609-919-1930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACILLO",
"first_name": "REX",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-02",
"last_updated": "2014-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NJ",
"license": "PTA40QB00242200",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "PA",
"license": "TEI002499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.