Active NPI
Carol Annette Roddey, M.S., PT
- Specialist
- Fayetteville, AR
National Provider Identifier
1164578274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- PT1149
- Practice address
- 2662 E Joyce Blvd
Ste 3
Fayetteville, AR 72703-4554 - Phone
- (479) 521-7337
- Fax
- (479) 521-7337
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT1149 | AR | Primary |
Addresses
Primary practice location
2662 E Joyce Blvd
Ste 3
Fayetteville, AR 72703-4554
Mailing address
4205 Cherokee CV
Springdale, AR 72764-7505
Phone (479) 756-6230
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5S238 | Other | AR | BLUE CROSS BLUE SHIELD |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT1149 | AR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1164578274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4205 CHEROKEE CV",
"city": "SPRINGDALE",
"state": "AR",
"postal_code": "727647505",
"telephone_number": "479-756-6230",
"fax_number": "479-521-7337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2662 E JOYCE BLVD",
"address_2": "STE 3",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034554",
"telephone_number": "479-521-7337",
"fax_number": "479-521-7337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODDEY",
"first_name": "CAROL",
"middle_name": "ANNETTE",
"credential": "M.S., PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-25",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": "PT1149",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "5S238",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.