Active NPI
Kevin Charles Groustra, M.S.P.T.
- Orthopedic Physical Therapist
- Little Rock, AR
National Provider Identifier
1316128499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 1146
- Practice address
- 9601 Interstate 630
Exit 7
Little Rock, AR 72205-7202 - Phone
- (501) 202-2685
- Fax
- (501) 202-2003
- NPI assigned
- Nov 17, 2007
- Last updated
- Nov 17, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 1146 | AR | Primary |
Addresses
Primary practice location
9601 Interstate 630
Exit 7
Little Rock, AR 72205-7202
Mailing address
9601 Interstate 630
Exit 7
Little Rock, AR 72205
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 |
|---|---|---|---|
| 1146 | AR | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northside Therapy Center Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapy Clinic/Center
- North Little Rock, AR
- NPI 1023054145
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195257600000",
"number": "1316128499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9601 INTERSTATE 630",
"address_2": "EXIT 7",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "72205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9601 INTERSTATE 630",
"address_2": "EXIT 7",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722057202",
"telephone_number": "501-202-2685",
"fax_number": "501-202-2003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROUSTRA",
"first_name": "KEVIN",
"middle_name": "CHARLES",
"credential": "M.S.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-17",
"last_updated": "2007-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "AR",
"license": "1146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.