Active NPI
Nathaniel L Pena, PT
- Physical Therapist
- Orange Park, FL
National Provider Identifier
1356595458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT12224
- Practice address
- 1248 Kingsley Ave
Orange Park, FL 32073-4699 - Phone
- (904) 269-7817
- Fax
- (904) 269-7817
- NPI assigned
- Nov 17, 2008
- 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 | PT12224 | FL | Primary |
Addresses
Primary practice location
1248 Kingsley Ave
Orange Park, FL 32073-4699
Mailing address
2222 Sullivan TRL
Easton, PA 18040-7958
Phone (800) 944-9782
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 |
|---|---|---|---|
| PT12224 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226880000000",
"number": "1356595458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2222 SULLIVAN TRL",
"city": "EASTON",
"state": "PA",
"postal_code": "180407958",
"telephone_number": "800-944-9782",
"fax_number": "610-438-2024"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1248 KINGSLEY AVE",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734699",
"telephone_number": "904-269-7817",
"fax_number": "904-269-7817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENA",
"first_name": "NATHANIEL",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-11-17",
"last_updated": "2008-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT12224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 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.