Jeremy Westbrook, PTA

Key facts

NPI

1134469141

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

5006 (TN)

Practice address

442 Delwood Dr
Columbus, MS 39702-9189

Phone

(662) 574-2409

NPI assigned

Feb 28, 2013

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 28, 2013.

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1134469141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 DELWOOD DR",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "39702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "442 DELWOOD DR",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397029189",
            "telephone_number": "662-574-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESTBROOK",
        "first_name": "JEREMY",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "5006",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A3871",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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