Active NPI
Divina Bautista
- Physical Therapist
- Memphis, TN
National Provider Identifier
1285881797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3526
- Practice address
- 6025 Primacy Pkwy
Memphis, TN 38119-5763 - Phone
- (901) 767-1040
- NPI assigned
- Aug 27, 2008
- 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 Therapist | 225100000X | 3526 | TN | Primary |
Addresses
Primary practice location
6025 Primacy Pkwy
Memphis, TN 38119-5763
Mailing address
2302 Londonderry LN
Cordova, TN 38016-8412
Phone (901) 381-1121
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 |
|---|---|---|---|
| 3526 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219795200000",
"number": "1285881797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2302 LONDONDERRY LN",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380168412",
"telephone_number": "901-381-1121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6025 PRIMACY PKWY",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381195763",
"telephone_number": "901-767-1040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "DIVINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-27",
"last_updated": "2008-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "3526",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.