Individual provider Active NPI

Rebekah Roessler

  • Athletic Trainer
  • Statesboro, GA
National Provider Identifier
1053761171
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
2000028531
Practice address
2687 Akins Blvd
Statesboro, GA 30458
Phone
(912) 478-5436
Fax
(912) 478-1892
NPI assigned
Jun 20, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 2000028531 Primary

Addresses

Primary practice location

2687 Akins Blvd
Statesboro, GA 30458

Mailing address

303 Kimberly LN
Saint Peters, MO 63376-4010
Phone (636) 248-9103

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

NPI Registry JSON

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1053761171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 KIMBERLY LN",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633764010",
            "telephone_number": "636-248-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2687 AKINS BLVD",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "30458",
            "telephone_number": "912-478-5436",
            "fax_number": "912-478-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROESSLER",
        "first_name": "REBEKAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": "2000028531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; 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.