Active NPI
Elizabeth Suzanne Sample, PT
- Physical Therapist
- Dickson, TN
National Provider Identifier
1366682585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8290
- Practice address
- 344 Henslee Dr
Suite 8
Dickson, TN 37055-2051 - Phone
- (615) 446-7623
- Fax
- (615) 446-7624
- NPI assigned
- Feb 27, 2009
- 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 | 8290 | TN | Primary |
Addresses
Primary practice location
344 Henslee Dr
Suite 8
Dickson, TN 37055-2051
Mailing address
2001 Mallory LN
Suite 201
Franklin, TN 37067-8233
Phone (615) 373-1350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8290 | Other | TN | TN STATE LICENSE |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agilitas USA, Inc | Physical Therapist | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235692800000",
"number": "1366682585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2001 MALLORY LN",
"address_2": "SUITE 201",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370678233",
"telephone_number": "615-373-1350",
"fax_number": "615-373-7116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "344 HENSLEE DR",
"address_2": "SUITE 8",
"city": "DICKSON",
"state": "TN",
"postal_code": "370552051",
"telephone_number": "615-446-7623",
"fax_number": "615-446-7624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMPLE",
"first_name": "ELIZABETH",
"middle_name": "SUZANNE",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-27",
"last_updated": "2009-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "8290",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TN STATE LICENSE",
"identifier": "8290",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dickson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.