Active NPI
David Clark Nolan, DPT PT OCS CSCS
- Physical Therapist
- Roxbury Crossing, MA
National Provider Identifier
1255430336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11462
- Practice address
- 1125 Tremont St
Roxbury Crossing, MA 02120-2178 - Phone
- (617) 267-3773
- Fax
- (617) 536-0819
- NPI assigned
- Sep 22, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11462 | MA | Primary |
Addresses
Primary practice location
1125 Tremont St
Roxbury Crossing, MA 02120-2178
Mailing address
535 S Main St
Randolph, MA 02368-5254
Phone (781) 961-3370
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 |
|---|---|---|---|
| 11462 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228089600000",
"number": "1255430336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 S MAIN ST",
"city": "RANDOLPH",
"state": "MA",
"postal_code": "023685254",
"telephone_number": "781-961-3370",
"fax_number": "781-767-7531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 TREMONT ST",
"city": "ROXBURY CROSSING",
"state": "MA",
"postal_code": "021202178",
"telephone_number": "617-267-3773",
"fax_number": "617-536-0819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLAN",
"first_name": "DAVID",
"middle_name": "CLARK",
"name_prefix": "Mr.",
"credential": "DPT PT OCS CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2008-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "11462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury Crossing, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.