Active NPI
Sean P Endebrock, PTA
- Physical Therapy Assistant
- Lebanon, OH
National Provider Identifier
1770127920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA.008421
- Practice address
- 96 Rough Way Unit 12
Lebanon, OH 45036-8187 - Phone
- (440) 796-2191
- NPI assigned
- Oct 31, 2019
- 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 Therapy Assistant | 225200000X | PTA.008421 | OH | Primary |
Addresses
Primary practice location
96 Rough Way Unit 12
Lebanon, OH 45036-8187
Mailing address
339 E Maple St
North Canton, OH 44720-2593
Phone (330) 498-8200
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA.008421 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572480000000",
"number": "1770127920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "339 E MAPLE ST",
"city": "NORTH CANTON",
"state": "OH",
"postal_code": "447202593",
"telephone_number": "330-498-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "96 ROUGH WAY UNIT 12",
"city": "LEBANON",
"state": "OH",
"postal_code": "450368187",
"telephone_number": "440-796-2191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENDEBROCK",
"first_name": "SEAN",
"middle_name": "P",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-31",
"last_updated": "2019-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "PTA.008421",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.