Active NPI
Kristen Prejean, PT
- Physical Therapist
- Park City, UT
National Provider Identifier
1063743581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1148623
- Practice address
- 1640 Redstone Ctr Dr
Park City, UT 84098-7605 - Phone
- (888) 800-8744
- NPI assigned
- Jan 22, 2010
- 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 | 1148623 | TX | Primary |
Addresses
Primary practice location
1640 Redstone Ctr Dr
Park City, UT 84098-7605
Mailing address
4713B Santa Anna St
Austin, TX 78721-2029
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 |
|---|---|---|---|
| 1148623 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264118400000",
"number": "1063743581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4713B SANTA ANNA ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787212029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 REDSTONE CTR DR",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840987605",
"telephone_number": "888-800-8744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREJEAN",
"first_name": "KRISTEN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-22",
"last_updated": "2010-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1148623",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.