Kyla Jo Tirtonegoro, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

07698 Issued in OH

Practice address

1171 Towne St
Cincinnati, OH 45216-2227

Phone

(513) 242-1360

NPI assigned

Dec 6, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1323129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323129600000",
    "number": "1194093096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1171 TOWNE ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452162227",
            "telephone_number": "513-242-1360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1171 TOWNE ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452162227",
            "telephone_number": "513-242-1360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIRTONEGORO",
        "first_name": "KYLA",
        "middle_name": "JO",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-06",
        "last_updated": "2011-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OH",
            "license": "07698",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2078125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Physical Therapy Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; 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.