Jordyn Roberts

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A6940 Issued in NC

Practice address

159 Crossover Rd
Beulaville, NC 28518-8801

Phone

(910) 298-6455

NPI assigned

Jul 15, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Rehabilitation Inc

  • Physical Therapist
  • Supply, NC
  • NPI 1427142561
  NPD
• Edwards and Associates Physical Therapy

  • Physical Medicine & Rehabilitation Physician
  • Beulaville, NC
  • NPI 1720670862
  NPD

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1114599446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 N BROWN RD",
            "city": "BEULAVILLE",
            "state": "NC",
            "postal_code": "285187703",
            "telephone_number": "423-782-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 CROSSOVER RD",
            "city": "BEULAVILLE",
            "state": "NC",
            "postal_code": "285188801",
            "telephone_number": "910-298-6455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JORDYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A6940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reform and Restore Services PLLC
• Amanda Register, CPNP
• Richard E. Fry, OD, PA
• Amy Richmond, PHARMD
• Rick E. Gilliland, D.M.D. P.a.
• Cynthia J Robinson
• Krista Curtis Shaw, LCSW
• Tracey Lynn Simmons-Kornegay, PHARMD
• Rebecca Lee Skillman
• Abigail Reeves Smith, M.S. CCC-SLP

• All providers in Beulaville, NC
• Physical Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.