Active NPI
Joan Hetter, PTA
- Physical Therapy Assistant
- Durham, NC
National Provider Identifier
1326313396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3615
- Practice address
- 5705 Fayetteville Rd
Durham, NC 27713-5318 - Phone
- (919) 434-6171
- NPI assigned
- Mar 9, 2012
- 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 | 3615 | NC | Primary |
Addresses
Primary practice location
5705 Fayetteville Rd
Durham, NC 27713-5318
Mailing address
505 Tryst LN
Wake Forest, NC 27587-1900
Phone (919) 830-5452
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 |
|---|---|---|---|
| 3615 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1331251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331251200000",
"number": "1326313396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 TRYST LN",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275871900",
"telephone_number": "919-830-5452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5705 FAYETTEVILLE RD",
"city": "DURHAM",
"state": "NC",
"postal_code": "277135318",
"telephone_number": "919-434-6171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETTER",
"first_name": "JOAN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-09",
"last_updated": "2012-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NC",
"license": "3615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.