Douglas Patrick Bevilacqua

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502000232 Issued in MI

Practice address

39901 Traditions Dr
Northville, MI 48168-9493

Phone

(248) 305-4400

Fax

(248) 305-4401

NPI assigned

Mar 6, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1891297883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36053 ALLEN ST",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481545212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39901 TRADITIONS DR",
            "city": "NORTHVILLE",
            "state": "MI",
            "postal_code": "481689493",
            "telephone_number": "248-305-4400",
            "fax_number": "248-305-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEVILACQUA",
        "first_name": "DOUGLAS",
        "middle_name": "PATRICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502000232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5502000232",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": null,
            "identifier": "5502000232",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandi Bernard, P.T.
• Joanne Bernard, LMSW, LCSW
• Georgia Bernwanger, RD
• Eric L Beshears, PH.D., L.P.
• Kristine Beveridge
• Fatima Samir Beydoun
• Mitesh Bhavsar
• Sahil S Bhullar
• Marsha Billes, DO
• Heather Bishop

• Physical Therapy Assistant in Northville, MI
• Providers in Northville, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.