Active NPI
Gerard Santos Eusebio, PTA
- Physical Therapy Assistant
- Canton, OH
National Provider Identifier
1285915140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA-5100
- Practice address
- 800 Market Ave N
Canton, OH 44702-1083 - Phone
- (330) 430-2119
- Fax
- (330) 452-1739
- NPI assigned
- Sep 6, 2011
- 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 Therapy Assistant | 225200000X | PTA-5100 | OH | Primary |
Addresses
Primary practice location
800 Market Ave N
Canton, OH 44702-1083
Mailing address
800 Market Ave N
Canton, OH 44702-1083
Phone (330) 430-2119
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 |
|---|---|---|---|
| PTA-5100 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1285915140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021083",
"telephone_number": "330-430-2119",
"fax_number": "330-452-1739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021083",
"telephone_number": "330-430-2119",
"fax_number": "330-452-1739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EUSEBIO",
"first_name": "GERARD",
"middle_name": "SANTOS",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-06",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "PTA-5100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.