Active NPI
Ila Suplizio, DPT
- Physical Therapist
- Roseville, CA
National Provider Identifier
1639563307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT42358
- Practice address
- 588 N Sunrise Ave
Ste. 100
Roseville, CA 95661-2842 - Phone
- (916) 782-7848
- Fax
- (916) 782-7855
- NPI assigned
- Mar 20, 2015
- 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 | PT42358 | CA | Primary |
Addresses
Primary practice location
588 N Sunrise Ave
Ste. 100
Roseville, CA 95661-2842
Mailing address
588 N Sunrise Ave
Ste. 100
Roseville, CA 95661-2842
Phone (916) 782-7848
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT42358 | Other | CA | LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT42358 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1426809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426809600000",
"number": "1639563307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "588 N SUNRISE AVE",
"address_2": "STE. 100",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956612842",
"telephone_number": "916-782-7848",
"fax_number": "916-782-7855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "588 N SUNRISE AVE",
"address_2": "STE. 100",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956612842",
"telephone_number": "916-782-7848",
"fax_number": "916-782-7855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPLIZIO",
"first_name": "ILA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-03-20",
"last_updated": "2015-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT42358",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "PT42358",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.