Active NPI
Tia Araceli Evangelista, PT, DPT
- Physical Therapist
- Kearny, NJ
National Provider Identifier
1417836743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA02306200
- Practice address
- 206 Bergen Ave
Kearny, NJ 07032-3384 - Phone
- (551) 580-7881
- NPI assigned
- Aug 29, 2025
- Sex
- Female
- 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 | 40QA02306200 | NJ | Primary |
Addresses
Primary practice location
206 Bergen Ave
Kearny, NJ 07032-3384
Mailing address
367 Van Nostrand Ave
Jersey City, NJ 07305-1308
Phone (201) 687-1939
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
576 Broadhollow Rd
Melville, NY 11747-5002
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA02306200 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756425600000",
"number": "1417836743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "367 VAN NOSTRAND AVE",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073051308",
"telephone_number": "201-687-1939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 BERGEN AVE",
"city": "KEARNY",
"state": "NJ",
"postal_code": "070323384",
"telephone_number": "551-580-7881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELISTA",
"first_name": "TIA",
"middle_name": "ARACELI",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-29",
"last_updated": "2025-08-29",
"certification_date": "2025-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA02306200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearny, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.