Khristinne S Menjivar, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004004 Issued in GA

Practice address

602 Oak St
Hinesville, GA 31313-3963

Phone

(912) 272-2920

NPI assigned

Mar 4, 2024

Last updated

Mar 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1709510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1194582486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 OAK ST",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133963",
            "telephone_number": "912-272-2920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 OAK ST",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133963",
            "telephone_number": "912-272-2920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENJIVAR",
        "first_name": "KHRISTINNE",
        "middle_name": "S",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luis David Mejia
• Sara Mejia, MA
• Jennifer Leigh Mele, RN
• Zana Zyquisha Melvin
• Dominique Marie Mendana
• Christina Merrill, LCSW
• Jose Esteban Mesa
• Bianca Mezier
• Kelly M Michaud, LPC
• Heather C Mignott, TRICHOLOGIST

• Physical Therapy Assistant in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.