Kentaria Shantell Roberts, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004881 Issued in GA

Practice address

1128 East Derenne Ave
Savannah, GA 31406

Phone

(912) 231-7900

NPI assigned

Jun 8, 2022

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": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1215666946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E DEER CT",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313203220",
            "telephone_number": "912-996-8055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1128 EAST DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31406",
            "telephone_number": "912-231-7900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3205 Deans Bridge Rd # Set9",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309064208",
            "country_code": "US",
            "telephone_number": "762-222-1123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KENTARIA",
        "middle_name": "SHANTELL",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alfred B Roberts III, DMD
• Casandra Roberts, PHARMD
• Deborah Roberts
• Jenifer Ellen Roberts, ATC
• Julie Gumban Roberts, LCSW
• Latoya Roberts
• Lindsey M Roberts, M.ED., CCC-SLP
• Lisa Roberts
• Matthew Rockwell Roberts, PA-C
• Megan Shane Roberts, NP

• Physical Therapy Assistant in Savannah, GA
• Providers in Savannah, 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 Jun 8, 2022; 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.