Active NPI
Amy Jolene Bevacqua, DPT
- Physical Therapist
- Meadville, PA
National Provider Identifier
1972080901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT018024
- Practice address
- 11277 Vernon PL
Meadville, PA 16335-3717 - Phone
- (814) 333-5214
- Fax
- (814) 333-1482
- NPI assigned
- Jul 23, 2018
- Sex
- Female
- Sole proprietor
- No
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 | PT018024 | PA | Primary |
Addresses
Primary practice location
11277 Vernon PL
Meadville, PA 16335-3717
Mailing address
13542 W Vernon Rd
Conneaut Lake, PA 16316-6748
Phone (814) 282-6995
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 |
|---|---|---|---|
| PT018024 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532304000000",
"number": "1972080901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13542 W VERNON RD",
"city": "CONNEAUT LAKE",
"state": "PA",
"postal_code": "163166748",
"telephone_number": "814-282-6995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11277 VERNON PL",
"city": "MEADVILLE",
"state": "PA",
"postal_code": "163353717",
"telephone_number": "814-333-5214",
"fax_number": "814-333-1482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVACQUA",
"first_name": "AMY",
"middle_name": "JOLENE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-23",
"last_updated": "2018-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT018024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meadville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.