Active NPI
Ryan Avellanosa
- Physical Therapist
- Hampshire, IL
National Provider Identifier
1679923551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070020390
- Practice address
- 184 S State St
Hampshire, IL 60140-7000 - Phone
- (847) 683-0077
- Fax
- (847) 683-1022
- NPI assigned
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070020390 | IL | Primary |
| Specialist | 174400000X | 070.020390 | IL |
Addresses
Primary practice location
184 S State St
Hampshire, IL 60140-7000
Mailing address
PO Box 200
Hampshire, IL 60140-0200
Phone (847) 683-0077
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 |
|---|---|---|---|
| 070.020390 | IL | MD | Specialist |
| 070020390 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466467200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1679923551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 200",
"city": "HAMPSHIRE",
"state": "IL",
"postal_code": "601400200",
"telephone_number": "847-683-0077",
"fax_number": "847-683-1022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "184 S STATE ST",
"city": "HAMPSHIRE",
"state": "IL",
"postal_code": "601407000",
"telephone_number": "847-683-0077",
"fax_number": "847-683-1022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVELLANOSA",
"first_name": "RYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-21",
"last_updated": "2023-03-07",
"certification_date": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070020390",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "070.020390",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hampshire, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.