Active NPI
Eldon Richard Kilpatrick, PTA
- Physical Therapy Assistant
- Mystic, CT
National Provider Identifier
1346415627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 000980
- Practice address
- 186 Jerry Browne Rd
Mystic, CT 06355 - Phone
- (866) 338-8892
- NPI assigned
- Apr 28, 2008
- Last updated
- Apr 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 000980 | CT | Primary |
Addresses
Primary practice location
186 Jerry Browne Rd
Mystic, CT 06355
Mailing address
333 1St Street North
Suite 200
Jacksonville Beach, FL 32250
Phone (904) 241-9231
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 |
|---|---|---|---|
| 000980 | CT | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209340800000",
"number": "1346415627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 1ST STREET NORTH",
"address_2": "SUITE 200",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "32250",
"telephone_number": "904-241-9231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "186 JERRY BROWNE RD",
"city": "MYSTIC",
"state": "CT",
"postal_code": "06355",
"telephone_number": "866-338-8892"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KILPATRICK",
"first_name": "ELDON",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-28",
"last_updated": "2008-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CT",
"license": "000980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mystic, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.