Eileen Engquist

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1634 Issued in FL

Practice address

9179 SE 130TH Loop
Summerfield, FL 34491-9452

Phone

(352) 452-0749

NPI assigned

Jan 15, 2012

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 15, 2012.

{
    "created_epoch": "1326585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326585600000",
    "number": "1245501717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9179 SE 130TH LOOP",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344919452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9179 SE 130TH LOOP",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344919452",
            "telephone_number": "352-452-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGQUIST",
        "first_name": "EILEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-15",
        "last_updated": "2012-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA1634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Summerfield, FL
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2012; 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.