Active NPI
Damon Anthony Formaini, MPT
- Physical Therapist
- Kittanning, PA
National Provider Identifier
1336216332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT010972L
- Practice address
- 5 Franklin Village Mall
Kittanning, PA 16201-8803 - Phone
- (724) 543-6452
- Fax
- (724) 543-5617
- NPI assigned
- Nov 29, 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 | PT010972L | PA | Primary |
Addresses
Primary practice location
5 Franklin Village Mall
Kittanning, PA 16201-8803
Mailing address
430 Innovation Drive
Blairsville, PA 15717-8096
Phone (724) 343-4060
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 457005 | Other | PA | HEALTH AMERICA-ASSURANCE |
| 232918467 | Other | PA | AETNA |
| FO1908605 | Other | PA | HIGHMARK BLUE SHIELD |
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 |
|---|---|---|---|
| PT010972L | PA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Rehabilitation and Health Services, Inc. | Past | Accepting new patients | |
| Phoenix Rehabilitation and Health Services, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- State College, PA
- NPI 1245588946
-
- Physical Therapist
- Cranberry Township, PA
- NPI 1720084155
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421280000000",
"number": "1336216332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 INNOVATION DRIVE",
"city": "BLAIRSVILLE",
"state": "PA",
"postal_code": "157178096",
"telephone_number": "724-343-4060",
"fax_number": "724-343-4069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 FRANKLIN VILLAGE MALL",
"city": "KITTANNING",
"state": "PA",
"postal_code": "162018803",
"telephone_number": "724-543-6452",
"fax_number": "724-543-5617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORMAINI",
"first_name": "DAMON",
"middle_name": "ANTHONY",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2015-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT010972L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH AMERICA-ASSURANCE",
"identifier": "457005",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "232918467",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "FO1908605",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kittanning, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.