Active NPI
Marisa Krisananuwatara
- Physical Therapy Assistant
- Austin, TX
National Provider Identifier
1336622646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2113050
- Practice address
- 12021 Metric Blvd
Austin, TX 78758-8616 - Phone
- (512) 228-3300
- NPI assigned
- Sep 12, 2018
- Last updated
- Sep 12, 2018
- 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 | 2113050 | TX | Primary |
Addresses
Primary practice location
12021 Metric Blvd
Austin, TX 78758-8616
Mailing address
6805 La Salle Dr
Austin, TX 78723-2211
Phone (151) 258-7447
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2113050 | Other | TX | PHYSICAL THERAPY ASSISTANT |
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 |
|---|---|---|---|
| 2113050 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536710400000",
"number": "1336622646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6805 LA SALLE DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787232211",
"telephone_number": "151-258-7447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 METRIC BLVD",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787588616",
"telephone_number": "512-228-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRISANANUWATARA",
"first_name": "MARISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-12",
"last_updated": "2018-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2113050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY ASSISTANT",
"identifier": "2113050",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.