Individual provider Active NPI

Mackenzie Bryson

  • Physical Therapy Assistant
  • Springfield, TN
National Provider Identifier
1073276929
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA0000007764 Issued in TN
Practice address
608 8TH Ave E
Springfield, TN 37172-2910
Phone
(615) 384-8453
NPI assigned
Oct 18, 2021
Last updated
Oct 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA0000007764 TN Primary

Addresses

Primary practice location

608 8TH Ave E
Springfield, TN 37172-2910

Mailing address

4951 Albert Fentress Rd
Greenbrier, TN 37073-5110
Phone (615) 995-2088

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

LicenseStateTypeSpecialty
PTA0000007764TNMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1073276929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 ALBERT FENTRESS RD",
            "city": "GREENBRIER",
            "state": "TN",
            "postal_code": "370735110",
            "telephone_number": "615-995-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 8TH AVE E",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371722910",
            "telephone_number": "615-384-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYSON",
        "first_name": "MACKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "PTA0000007764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.

Verify at the official NPI Registry.