Active NPI
Nicolas Civale
- Physical Therapist
- Irving, TX
National Provider Identifier
1356808463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 011659
- Practice address
- 5001 Statesman Dr
Irving, TX 75063-2414 - Phone
- (469) 524-1506
- NPI assigned
- Feb 25, 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 | 011659 | CT | Primary |
Addresses
Primary practice location
5001 Statesman Dr
Irving, TX 75063-2414
Mailing address
129 Greenwoods LN
East Windsor, CT 06088-9692
Phone (860) 372-8013
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230331002228 | CT | Practitioner - Physical Therapist in Private Practice | 0648645804 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Evolution Physical Therapy LLC
Practice addresses (Care Compare)
349 Post Rd
Darien, CT 06820-3606
Phone (475) 209-9420
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11659 | CT | MD | General Practice Dentistry |
| 011659 | CT | MD | Physical Therapist |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1356808463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 GREENWOODS LN",
"city": "EAST WINDSOR",
"state": "CT",
"postal_code": "060889692",
"telephone_number": "860-372-8013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5001 STATESMAN DR",
"city": "IRVING",
"state": "TX",
"postal_code": "750632414",
"telephone_number": "469-524-1506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIVALE",
"first_name": "NICOLAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-25",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CT",
"license": "011659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.