Active NPI
Liza M Goossens, PTA
- Physical Therapy Assistant
- Covington, TN
National Provider Identifier
1104151331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4557
- Practice address
- 765 Bert Johnston Ave
Covington, TN 38019-2414 - Phone
- (901) 475-0027
- NPI assigned
- Oct 6, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 4557 | TN | Primary |
Addresses
Primary practice location
765 Bert Johnston Ave
Covington, TN 38019-2414
Mailing address
63 Comanche Dr
Millington, TN 38053-1015
Phone (901) 262-1383
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 |
|---|---|---|---|
| 4557 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254787200000",
"number": "1104151331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 COMANCHE DR",
"city": "MILLINGTON",
"state": "TN",
"postal_code": "380531015",
"telephone_number": "901-262-1383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "765 BERT JOHNSTON AVE",
"city": "COVINGTON",
"state": "TN",
"postal_code": "380192414",
"telephone_number": "901-475-0027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOSSENS",
"first_name": "LIZA",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-10-06",
"last_updated": "2009-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "4557",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covington, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.