NPIMap

Individual provider Active NPI

Emmanuella Davilus, P.T.A

  • Physical Therapy Assistant
  • Brockton, MA
National Provider Identifier
1225201056
Registry record updated Apr 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
8054 Issued in MA
Practice address
40 Reservoir St
#212
Brockton, MA 02301-1166
Phone
(617) 792-9497
NPI assigned
Apr 13, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 8054 MA Primary
Physical Therapy Assistant 225200000X

Addresses

Primary practice location

40 Reservoir St
#212
Brockton, MA 02301-1166

Mailing address

40 Reservoir St
#212
Brockton, MA 02301-1166
Phone (617) 792-9497

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

LicenseStateTypeSpecialty
8054MAMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208044800000",
    "number": "1225201056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 RESERVOIR ST",
            "address_2": "#212",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011166",
            "telephone_number": "617-792-9497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 RESERVOIR ST",
            "address_2": "#212",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011166",
            "telephone_number": "617-792-9497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVILUS",
        "first_name": "EMMANUELLA",
        "name_prefix": "Ms.",
        "credential": "P.T.A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-13",
        "last_updated": "2008-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MA",
            "license": "8054",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.