Active NPI
Tracy Suzanne Roberts-Hislop, DPT
- Physical Therapist
- Corona, CA
National Provider Identifier
1336498211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 39348
- Practice address
- 886 Magnolia Ave
Suite 100
Corona, CA 92879-3105 - Phone
- (951) 340-3402
- Fax
- (951) 340-3416
- NPI assigned
- Sep 6, 2012
- Last updated
- Dec 17, 2015
- 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 Therapist | 225100000X | PT 39348 | CA | Primary |
Addresses
Primary practice location
886 Magnolia Ave
Suite 100
Corona, CA 92879-3105
Mailing address
24630 Washington Ave
Ste. 200
Murrieta, CA 92562-6131
Phone (951) 696-9353
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 39348 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450310400000",
"number": "1336498211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24630 WASHINGTON AVE",
"address_2": "STE. 200",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925626131",
"telephone_number": "951-696-9353",
"fax_number": "951-973-7216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "886 MAGNOLIA AVE",
"address_2": "SUITE 100",
"city": "CORONA",
"state": "CA",
"postal_code": "928793105",
"telephone_number": "951-340-3402",
"fax_number": "951-340-3416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS-HISLOP",
"first_name": "TRACY",
"middle_name": "SUZANNE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-06",
"last_updated": "2015-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 39348",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
- Rje Solutions LLC (1Heart Caregiver Services)
- RM Elite Rehab Group, Inc. (Sports Specific Rehab)
- RMC Surgery Center LLC (RMC Surgery Center)
- Robert Shun-I Wang & Lan Nguyet Nguyen Dental Corporation (Corona Kids Dentistry)
- Roberto Vasquez, a Dental Corp
- Connie N/a Roberts
- Denise Adriane Roberts, DNP,MSN-ED,RN
- Marlyne Diane Roberts, L.M.F.T.
- Tiona Mytish Robertson, NP
- Ladonna Lisa Robinson, BSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.