Brian Adam Eppolito, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT003374 Issued in KY

Practice address

1110 Wilkinson Trce
Bowling Green, KY 42103-3402

Phone

(270) 796-6850

Fax

(270) 781-8228

NPI assigned

Dec 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669540290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 641268",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452640304",
            "telephone_number": "270-745-1120",
            "fax_number": "270-745-1156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 WILKINSON TRCE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421033402",
            "telephone_number": "270-796-6850",
            "fax_number": "270-781-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EPPOLITO",
        "first_name": "BRIAN",
        "middle_name": "ADAM",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "PT003374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GROUP # 91011148",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI #",
            "identifier": "1760411342",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Bowling Green, KY
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.