Active NPI
Edward Dechellis Jr., PTA, MT
- Massage Therapist
- Northfield, MA
National Provider Identifier
1821441577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 6291
- Practice address
- 233 Old Wendell Rd
Northfield, MA 01360-9674 - Phone
- (413) 218-6715
- NPI assigned
- Jul 18, 2016
- Last updated
- Jul 18, 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 Therapy Assistant | 225200000X | 3729 | MA | |
| Massage Therapist | 225700000X | 6291 | MA | Primary |
Addresses
Primary practice location
233 Old Wendell Rd
Northfield, MA 01360-9674
Mailing address
233 Old Wendell Rd
Northfield, MA 01360-9674
Phone (413) 218-6715
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3729 | MA | MD | Registered Dietitian |
| 6291 | MA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468800000000",
"number": "1821441577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 OLD WENDELL RD",
"city": "NORTHFIELD",
"state": "MA",
"postal_code": "013609674",
"telephone_number": "413-218-6715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "233 OLD WENDELL RD",
"city": "NORTHFIELD",
"state": "MA",
"postal_code": "013609674",
"telephone_number": "413-218-6715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECHELLIS",
"first_name": "EDWARD",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PTA, MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-18",
"last_updated": "2016-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "3729",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MA",
"license": "6291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.