Active NPI
Trista Brown, MS, PT
- Pediatric Physical Therapist
- Lakeland, FL
National Provider Identifier
1033307236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT26098
- Practice address
- 716 E Bella Vista St
Lakeland, FL 33805 - Phone
- (863) 683-6504
- Fax
- (863) 688-9292
- NPI assigned
- Oct 12, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 26098 | FL | |
| Pediatric Physical Therapist | 2251P0200X | PT26098 | FL | Primary |
Addresses
Primary practice location
716 E Bella Vista St
Lakeland, FL 33805
Mailing address
716 E Bella Vista St
Lakeland, FL 33805
Phone (863) 683-6504
Other names 1
- Trista Bratlee
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26098 | FL | MD | Physical Therapist |
| PT26098 | FL | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Therapy Services Inc | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621382400000",
"number": "1033307236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "716 E BELLA VISTA ST",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33805",
"telephone_number": "863-683-6504",
"fax_number": "863-688-9292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "716 E BELLA VISTA ST",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33805",
"telephone_number": "863-683-6504",
"fax_number": "863-688-9292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "TRISTA",
"name_prefix": "Mrs.",
"credential": "MS, PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-12",
"last_updated": "2021-05-19",
"certification_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "26098",
"primary": false
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "FL",
"license": "PT26098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRISTA",
"last_name": "BRATLEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.