Active NPI
Ethan Thomas Pravetz, PT, DPT, CCI
- Physical Therapist
- Cherry Hill, NJ
National Provider Identifier
1659723393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 042312-1
- Practice address
- 7 Carnegie PLZ
Cherry Hill, NJ 08003-1000 - Phone
- (877) 407-3422
- NPI assigned
- Jul 6, 2016
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 040.0124005 | VT | |
| Physical Therapist | 225100000X | 4111 | NH | |
| Physical Therapist | 225100000X | 22214 | MA | |
| Physical Therapist | 225100000X | 042312-1 | NY | Primary |
Addresses
Primary practice location
7 Carnegie PLZ
Cherry Hill, NJ 08003-1000
Mailing address
1086 Amsterdam Ave Apt 2a
New York, NY 10031
Other practice location 1
677 Court St
Keene, NH 03431-1702
Phone (603) 354-4157
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 |
|---|---|---|---|
| 22214 | MA | MD | Pharmacist |
| 4111 | NH | MD | Physical Therapist |
| 040.0124005 | VT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586995200000",
"number": "1659723393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1086 AMSTERDAM AVE APT 2A",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 CARNEGIE PLZ",
"city": "CHERRY HILL",
"state": "NJ",
"postal_code": "080031000",
"telephone_number": "877-407-3422"
}
],
"practiceLocations": [
{
"address_1": "677 Court St",
"address_purpose": "LOCATION",
"city": "Keene",
"state": "NH",
"postal_code": "034311702",
"country_code": "US",
"telephone_number": "603-354-4157",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PRAVETZ",
"first_name": "ETHAN",
"middle_name": "THOMAS",
"credential": "PT, DPT, CCI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-06",
"last_updated": "2020-04-16",
"certification_date": "2020-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VT",
"license": "040.0124005",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NH",
"license": "4111",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "22214",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "042312-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cherry Hill, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.