Active NPI
Matthew Bevilacqua
- Physical Therapist
- Beverly, MA
National Provider Identifier
1679091821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 23292
- Practice address
- 7 Reservoir Rd
Beverly, MA 01915-5501 - Phone
- (978) 524-0333
- NPI assigned
- Sep 7, 2017
- Last updated
- Jun 16, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 23292 | MA | Primary |
Addresses
Primary practice location
7 Reservoir Rd
Beverly, MA 01915-5501
Mailing address
7 Reservoir Rd
Beverly, MA 01915-5501
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 |
|---|---|---|---|
| 23292 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1679091821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 RESERVOIR RD",
"city": "BEVERLY",
"state": "MA",
"postal_code": "019155501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 RESERVOIR RD",
"city": "BEVERLY",
"state": "MA",
"postal_code": "019155501",
"telephone_number": "978-524-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVILACQUA",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-07",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "23292",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beverly, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.