Active NPI
Azana J Ezekiel, PTA
- Physical Therapy Assistant
- Lorton, VA
National Provider Identifier
1265111850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 7924
- Practice address
- 9455 Lorton Market St Ste 201
Lorton, VA 22079-1965 - Phone
- (703) 647-3120
- NPI assigned
- Jul 12, 2023
- Last updated
- Sep 24, 2023
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 7924 | TN | Primary |
Addresses
Primary practice location
9455 Lorton Market St Ste 201
Lorton, VA 22079-1965
Mailing address
135 N Park PL Ste 210
Stockbridge, GA 30281-7209
Phone (770) 627-0869
Other practice location 1
501 Adesa Blvd
Lenoir City, TN 37771-6725
Phone (865) 333-1461
Other practice location 2
101 Fort Sanders West Blvd
Knoxville, TN 37922-3342
Phone (865) 895-3000
Other practice location 3
135 N Park Pl Ste 210
Stockbridge, GA 30281-7209
Phone (770) 627-0869
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 |
|---|---|---|---|
| 7924 | TN | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695513600000",
"number": "1265111850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "135 N PARK PL STE 210",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302817209",
"telephone_number": "770-627-0869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9455 LORTON MARKET ST STE 201",
"city": "LORTON",
"state": "VA",
"postal_code": "220791965",
"telephone_number": "703-647-3120"
}
],
"practiceLocations": [
{
"address_1": "501 Adesa Blvd",
"address_purpose": "LOCATION",
"city": "Lenoir City",
"state": "TN",
"postal_code": "377716725",
"country_code": "US",
"telephone_number": "865-333-1461",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "101 Fort Sanders West Blvd",
"address_purpose": "LOCATION",
"city": "Knoxville",
"state": "TN",
"postal_code": "379223342",
"country_code": "US",
"telephone_number": "865-895-3000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "135 N Park Pl Ste 210",
"address_purpose": "LOCATION",
"city": "Stockbridge",
"state": "GA",
"postal_code": "302817209",
"country_code": "US",
"telephone_number": "770-627-0869",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EZEKIEL",
"first_name": "AZANA",
"middle_name": "J",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-12",
"last_updated": "2023-09-24",
"certification_date": "2023-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "7924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lorton, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.