Individual provider Active NPI

Jerodine N Mukweyi

  • Physical Therapist
  • San Antonio, TX
National Provider Identifier
1134553605
Registry record updated Sep 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1224887 Issued in TX
Practice address
1310 McCullough Ave
San Antonio, TX 78212-5601
Phone
(210) 757-2278
NPI assigned
Sep 2, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2013

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 1224887 TX Primary

Addresses

Primary practice location

1310 McCullough Ave
San Antonio, TX 78212-5601

Mailing address

11700 Wallstreet
15205
San Antonio, TX 78230-1718

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

NPI Registry JSON

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

{
    "created_epoch": "1378080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378080000000",
    "number": "1134553605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11700 WALLSTREET",
            "address_2": "15205",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 MCCULLOUGH AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782125601",
            "telephone_number": "210-757-2278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUKWEYI",
        "first_name": "JERODINE",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-02",
        "last_updated": "2013-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1224887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2013; 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.