Individual provider Active NPI

Krystal Hillis

  • Physical Therapy Assistant
  • Odessa, TX
National Provider Identifier
1164038683
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
2156614 Issued in TX
Practice address
2760 N Grandview Ave Ste a
Odessa, TX 79762-6953
Phone
(432) 552-7034
NPI assigned
Sep 21, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2156614 TX Primary

Addresses

Primary practice location

2760 N Grandview Ave Ste a
Odessa, TX 79762-6953

Mailing address

4311 Andrews Hwy
Midland, TX 79703-4823
Phone (432) 520-5600

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

LicenseStateTypeSpecialty
2156614TXMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optimus Physical Therapy and Orthosport Specialists PLLC CurrentSince Sep 27, 2020 Accepting new patients
Joanna Lynn Riley PastSince Sep 27, 2020 Accepting new patients

Locations

4311 Andrews Hwy
Midland, TX 79703
Phone (432) 520-5600

2760 N Grandview Ave
Ste A
Odessa, TX 79762
Phone (432) 552-7034

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1164038683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 ANDREWS HWY",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797034823",
            "telephone_number": "432-520-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 N GRANDVIEW AVE STE A",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797626953",
            "telephone_number": "432-552-7034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILLIS",
        "first_name": "KRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-21",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2156614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; 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.