Individual provider Active NPI

Martha Jennings, PT

  • Physical Therapist
  • Texarkana, TX
National Provider Identifier
1023391794
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1140978 Issued in TX
Practice address
4824 McKnight Rd
Texarkana, TX 75503-0935
Phone
(903) 793-6135
Fax
(903) 793-0053
NPI assigned
Sep 20, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1140978 TX Primary

Addresses

Primary practice location

4824 McKnight Rd
Texarkana, TX 75503-0935

Mailing address

119 Oakview Dr
Texarkana, TX 75501-0963
Phone (903) 334-7476

Other practice location 1

3410 Magnolia St
Texarkana, TX 75503-3729
Phone (903) 792-3003

Other identifiers 3

IdentifierTypeStateIssuer
1140978OtherTXSTATE LICENSE NUMBER
195157721MedicaidAR
288237501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221202002190 TX Practitioner - Physical Therapist in Private Practice 1658740261 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1140978TXMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pearson Pediatric OT Services Physical Therapist CurrentSince Jul 15, 2022 Accepting new patients
Therapy Options of Texarkana, Inc. Physical Therapist Past Accepting new patients
Therapy Options of Texarkana, Inc Physical Therapist Past Accepting new patients

Locations

3718 Summerhill Rd
Texarkana, TX 75503
Phone (903) 793-6135

4824 McKnight Rd
Texarkana, TX 75503
Phone (903) 614-5800

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1316476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1023391794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 OAKVIEW DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755010963",
            "telephone_number": "903-334-7476",
            "fax_number": "870-774-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4824 MCKNIGHT RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755030935",
            "telephone_number": "903-793-6135",
            "fax_number": "903-793-0053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3410 Magnolia St",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755033729",
            "country_code": "US",
            "telephone_number": "903-792-3003",
            "fax_number": "903-794-1005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "MARTHA",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-20",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1140978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "1140978",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "195157721",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288237501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.