Active NPI
Kesia Derilus
- Physical Therapy Assistant
- Duncanville, TX
National Provider Identifier
1215690227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2144804
- Practice address
- 814 E Camp Wisdom Rd
Duncanville, TX 75116-2828 - Phone
- (214) 217-0303
- NPI assigned
- Oct 16, 2021
- Last updated
- Oct 16, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2144804 | TX | Primary |
Addresses
Primary practice location
814 E Camp Wisdom Rd
Duncanville, TX 75116-2828
Mailing address
12660 Hillcrest Rd Apt 6201
Dallas, TX 75230-2028
Phone (954) 560-0951
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2144804 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634342400000",
"number": "1215690227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12660 HILLCREST RD APT 6201",
"city": "DALLAS",
"state": "TX",
"postal_code": "752302028",
"telephone_number": "954-560-0951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "814 E CAMP WISDOM RD",
"city": "DUNCANVILLE",
"state": "TX",
"postal_code": "751162828",
"telephone_number": "214-217-0303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERILUS",
"first_name": "KESIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-16",
"last_updated": "2021-10-16",
"certification_date": "2021-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2144804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duncanville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.