Active NPI
Phillip Tavolacci, MSPT
- Physical Therapist
- Silver Spring, MD
National Provider Identifier
1891349569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 21271
- Practice address
- 407 Leighton Ave
Silver Spring, MD 20901-4823 - Phone
- (301) 652-2522
- NPI assigned
- Jul 30, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 21271 | MD | Primary |
Addresses
Primary practice location
407 Leighton Ave
Silver Spring, MD 20901-4823
Mailing address
407 Leighton Ave
Silver Spring, MD 20901-4823
Phone (301) 652-2522
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 |
|---|---|---|---|
| 21271 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564444800000",
"number": "1891349569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 LEIGHTON AVE",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209014823",
"telephone_number": "301-652-2522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 LEIGHTON AVE",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209014823",
"telephone_number": "301-652-2522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAVOLACCI",
"first_name": "PHILLIP",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-30",
"last_updated": "2019-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "21271",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.