Individual provider Active NPI

Amanda R Kesterson, DPT

  • Physical Therapist
  • Hermitage, TN
National Provider Identifier
1104266550
Registry record updated Apr 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9615 Issued in TN
Practice address
275 Jackson Meadows Dr Ste 101
Hermitage, TN 37076-1454
Phone
(615) 885-7848
Fax
(615) 885-8292
NPI assigned
Jun 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 9615 TN Primary

Addresses

Primary practice location

275 Jackson Meadows Dr Ste 101
Hermitage, TN 37076-1454

Mailing address

8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-8923

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

LicenseStateTypeSpecialty
9615TNMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1372550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492041600000",
    "number": "1104266550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-8923",
            "fax_number": "423-954-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 JACKSON MEADOWS DR STE 101",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370761454",
            "telephone_number": "615-885-7848",
            "fax_number": "615-885-8292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESTERSON",
        "first_name": "AMANDA",
        "middle_name": "R",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-30",
        "last_updated": "2017-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "9615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermitage, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.