Active NPI
Jeffrey R Rosas, PTA
- Rehabilitation Practitioner
- Waco, TX
National Provider Identifier
1083279947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 2101112
- Practice address
- 1900 W State Highway 6
Waco, TX 76712-9729 - Phone
- (254) 776-9681
- NPI assigned
- May 7, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 2101112 | TX | Primary |
Addresses
Primary practice location
1900 W State Highway 6
Waco, TX 76712-9729
Mailing address
1900 W Hwy 6
Waco, TX 76712
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 452639073 | Other | TX | RELIANT REHAB |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2101112 | TX | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557187200000",
"number": "1083279947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 W HWY 6",
"city": "WACO",
"state": "TX",
"postal_code": "76712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 W STATE HIGHWAY 6",
"city": "WACO",
"state": "TX",
"postal_code": "767129729",
"telephone_number": "254-776-9681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSAS",
"first_name": "JEFFREY",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-07",
"last_updated": "2019-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "TX",
"license": "2101112",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RELIANT REHAB",
"identifier": "452639073",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.