Emerelli, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

EMERELLI, PLLC

Doing business as

Restorative Physical Therapy

Practice address

2714 Osler Blvd
Bryan, TX 77802-2517

Phone

(979) 776-2225

Fax

(979) 776-7945

NPI assigned

Oct 22, 2024

Last updated

Oct 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Katie Davenport, PT, DPT, COMTNPI 1457805707

Title

Physical Therapist

Phone

(979) 776-2225

Specialties & licenses 6

Addresses

Other names 1

• Restorative Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katie Marie Davenport, PT, DPT

  • Physical Therapist
  • Bryan, TX
  • NPI 1457805707
  Medicare reassignment NPD Authorized official
• Leon F. Bradway III, PHYSICIAL THERAPIST

  • Physical Therapist
  • College Station, TX
  • NPI 1932179306
  Medicare reassignment NPD
• Tyler Wilson

  • Physical Therapist
  • Bryan, TX
  • NPI 1639947666
  NPD
• Suzanne D Black, M.D.

  • Family Medicine Physician
  • Bryan, TX
  • NPI 1720082167
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1336960301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55",
            "city": "WELLBORN",
            "state": "TX",
            "postal_code": "778810055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2714 OSLER BLVD",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022517",
            "telephone_number": "979-776-2225",
            "fax_number": "979-776-7945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERELLI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-22",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "979-776-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, COMT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251E1300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Electrophysiology, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Human Factors",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restorative Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapist in Bryan, TX
• Providers in Bryan, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.