Active NPI
Nathaniel Cercavschi, PT, DPT, ATC
- Physical Therapist
- Oak Park, IL
National Provider Identifier
1215337753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070021062
- Practice address
- 610 S Maple Ave
Oak Park, IL 60304-1091 - Phone
- (708) 934-7062
- NPI assigned
- Sep 3, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070021062 | IL | Primary |
| Athletic Trainer | 2255A2300X | 096003025 | IL |
Addresses
Primary practice location
610 S Maple Ave
Oak Park, IL 60304-1091
Mailing address
610 S Maple Ave
Oak Park, IL 60304-1091
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070021062 | IL | MD | Physical Therapist |
| 096003025 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409702400000",
"number": "1215337753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 S MAPLE AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 S MAPLE AVE",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041091",
"telephone_number": "708-934-7062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERCAVSCHI",
"first_name": "NATHANIEL",
"credential": "PT, DPT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-03",
"last_updated": "2014-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070021062",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096003025",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.