Active NPI
Neil Timothy Ponce Edillon, PT
- Physical Therapist
- Bowie, MD
National Provider Identifier
1326698341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 27547
- Practice address
- 4000 Mitchellville Rd Ste A414
Bowie, MD 20716-3142 - Phone
- (301) 860-0985
- Fax
- (301) 860-0978
- NPI assigned
- Sep 12, 2019
- 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 | 27547 | MD | Primary |
Addresses
Primary practice location
4000 Mitchellville Rd Ste A414
Bowie, MD 20716-3142
Mailing address
131 Main St Ste 202
Prince Frederick, MD 20678-3341
Phone (410) 535-6975
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 |
|---|---|---|---|
| 27547 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575417600000",
"number": "1326698341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 MAIN ST STE 202",
"city": "PRINCE FREDERICK",
"state": "MD",
"postal_code": "206783341",
"telephone_number": "410-535-6975",
"fax_number": "410-535-6915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 MITCHELLVILLE RD STE A414",
"city": "BOWIE",
"state": "MD",
"postal_code": "207163142",
"telephone_number": "301-860-0985",
"fax_number": "301-860-0978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDILLON",
"first_name": "NEIL TIMOTHY",
"middle_name": "PONCE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-12",
"last_updated": "2019-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "27547",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.