Active NPI
Ryan Catoltol Dacillo
- Physical Therapist
- Middletown, NJ
National Provider Identifier
1790010353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 032480
- Practice address
- 1108 Knollwood Dr
Middletown, NJ 07748-2854 - Phone
- (732) 320-3184
- NPI assigned
- Oct 14, 2009
- 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 Therapy Assistant | 225200000X | 006517 | NY | |
| Physical Therapist | 225100000X | 032480 | NY | Primary |
Addresses
Primary practice location
1108 Knollwood Dr
Middletown, NJ 07748-2854
Mailing address
1108 Knollwood Dr
Middletown, NJ 07748-2854
Phone (732) 320-3184
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 |
|---|---|---|---|
| 006517 | NY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274313600000",
"number": "1790010353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1108 KNOLLWOOD DR",
"city": "MIDDLETOWN",
"state": "NJ",
"postal_code": "077482854",
"telephone_number": "732-320-3184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 KNOLLWOOD DR",
"city": "MIDDLETOWN",
"state": "NJ",
"postal_code": "077482854",
"telephone_number": "732-320-3184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DACILLO",
"first_name": "RYAN",
"middle_name": "CATOLTOL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-14",
"last_updated": "2010-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "006517",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "032480",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middletown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.