Angelina Fidelino Melocoton, P.T.

Key facts

NPI

1689829699

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

070008877 (IL)

Practice address

2625 Kipling Dr
Springfield, IL 62711-6232

Phone

(217) 220-2861

Fax

(217) 698-8287

NPI assigned

Nov 19, 2008

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2008.

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227052800000",
    "number": "1689829699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 KIPLING DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116232",
            "telephone_number": "217-220-2861",
            "fax_number": "217-698-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 KIPLING DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116232",
            "telephone_number": "217-220-2861",
            "fax_number": "217-698-8287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELOCOTON",
        "first_name": "ANGELINA",
        "middle_name": "FIDELINO",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070008877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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