Individual provider Active NPI

Brian Patrick Ervin, PT, DPT

  • Physical Therapist
  • Melrose Park, IL
National Provider Identifier
1376903252
Registry record updated Mar 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.019934 Issued in IL
Practice address
1111 Superior St
Outpatient Physical Therapy
Melrose Park, IL 60160-4138
Phone
(708) 938-7408
Fax
(708) 938-7955
NPI assigned
Mar 4, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.019934 IL Primary

Addresses

Primary practice location

1111 Superior St
Outpatient Physical Therapy
Melrose Park, IL 60160-4138

Mailing address

1111 Superior St
Outpatient Physical Therapy
Melrose Park, IL 60160-4138
Phone (708) 938-7408

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

LicenseStateTypeSpecialty
070.019934ILMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1376903252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 SUPERIOR ST",
            "address_2": "OUTPATIENT PHYSICAL THERAPY",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601604138",
            "telephone_number": "708-938-7408",
            "fax_number": "708-938-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SUPERIOR ST",
            "address_2": "OUTPATIENT PHYSICAL THERAPY",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601604138",
            "telephone_number": "708-938-7408",
            "fax_number": "708-938-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERVIN",
        "first_name": "BRIAN",
        "middle_name": "PATRICK",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.019934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.