Active NPI
Mary Ann Gaetos, PTA
- Physical Therapy Assistant
- La Crescenta, CA
National Provider Identifier
1598304032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA9523
- Practice address
- 2706 Starfall Dr
La Crescenta, CA 91214-1444 - Phone
- (323) 684-7285
- NPI assigned
- Jan 1, 2020
- Sex
- Female
- 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 | PTA9523 | CA | Primary |
Addresses
Primary practice location
2706 Starfall Dr
La Crescenta, CA 91214-1444
Mailing address
2706 Starfall Dr
La Crescenta, CA 91214-1444
Phone (323) 684-7285
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 |
|---|---|---|---|
| PTA9523 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578009600000",
"number": "1598304032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2706 STARFALL DR",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "912141444",
"telephone_number": "323-684-7285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2706 STARFALL DR",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "912141444",
"telephone_number": "323-684-7285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAETOS",
"first_name": "MARY ANN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-01",
"last_updated": "2020-01-03",
"certification_date": "2020-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "PTA9523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Crescenta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.