Individual provider Active NPI

Keosha Lashell Houston, PTA

  • Physical Therapy Assistant
  • Fayetteville, NC
National Provider Identifier
1316438252
Registry record updated May 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
A4470 Issued in NC
Practice address
424 McArthur Rd
Fayetteville, NC 28311-6924
Phone
(910) 868-2002
Fax
(910) 868-2004
NPI assigned
May 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X A4470 NC Primary

Addresses

Primary practice location

424 McArthur Rd
Fayetteville, NC 28311-6924

Mailing address

2757 Mewborn Church Rd
Snow Hill, NC 28580-8973
Phone (615) 426-6174

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

LicenseStateTypeSpecialty
A4470NCMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
RDL Therapeutic Outpatient Therapy Physical Therapy Assistant PastSince Sep 2, 2019 Accepting new patients
Sozo Family Care Home Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527292800000",
    "number": "1316438252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2757 MEWBORN CHURCH RD",
            "city": "SNOW HILL",
            "state": "NC",
            "postal_code": "285808973",
            "telephone_number": "615-426-6174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 MCARTHUR RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283116924",
            "telephone_number": "910-868-2002",
            "fax_number": "910-868-2004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSTON",
        "first_name": "KEOSHA",
        "middle_name": "LASHELL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-26",
        "last_updated": "2018-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "A4470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2018; 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.