Individual provider Active NPI

Danielle Auclair, MPT, DPT

  • Physical Therapist
  • Brockton, MA
National Provider Identifier
1770505240
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
15886 Issued in MA
Practice address
110 Liberty St
Suite 1300
Brockton, MA 02301-5521
Phone
(508) 580-0144
Fax
(508) 580-0449
NPI assigned
Jul 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 15886 MA Primary

Addresses

Primary practice location

110 Liberty St
Suite 1300
Brockton, MA 02301-5521

Mailing address

322 E Center St
West Bridgewater, MA 02379-1824
Phone (508) 559-0993

Other identifiers 4

IdentifierTypeStateIssuer
0716502MedicaidMA
496868OtherMATUFTS
Y68689OtherMABLUECROSS BLUESHIELD
000000044651OtherMABOSTON MEDICAL CENTER HEALTHNET

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220610002327 SC Practitioner - Physical Therapist in Private Practice 5890898654 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Physical Therapy LLCGroup PAC ID 2769915347, 25 clinicians

Practice addresses (Care Compare)

2050 Corporate Centre Dr
Myrtle Beach, SC 29577-7428
Phone (843) 443-9368

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Physical Therapy LLC Physical Therapist CurrentSince Nov 1, 2024 Accepting new patients
Fitness Forum Services LLC Physical Therapist Past Accepting new patients

Locations

815 Highway 378
Lexington, SC 29072
Phone (803) 359-5533

2050 Corporate Centre Dr
Myrtle Beach, SC 29577
Phone (843) 443-9368

2050 Corporate Centre Dr
Ste 100
Myrtle Beach, SC 29577
Phone (843) 443-9368

1510 Ribaut Rd
Port Royal, SC 29935
Phone (843) 524-3241

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1770505240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 E CENTER ST",
            "city": "WEST BRIDGEWATER",
            "state": "MA",
            "postal_code": "023791824",
            "telephone_number": "508-559-0993",
            "fax_number": "508-559-5072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "address_2": "SUITE 1300",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015521",
            "telephone_number": "508-580-0144",
            "fax_number": "508-580-0449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUCLAIR",
        "first_name": "DANIELLE",
        "credential": "MPT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "15886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0716502",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "496868",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "Y68689",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOSTON MEDICAL CENTER HEALTHNET",
            "identifier": "000000044651",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.