Active NPI
Ridge Theo Vista
- Physical Therapy Assistant
- Brownsville, TX
National Provider Identifier
1376022798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2140746
- Practice address
- 871 Old Alice Rd Ste 100
Brownsville, TX 78520-8269 - Phone
- (956) 554-0006
- NPI assigned
- Aug 7, 2018
- Sex
- Male
- 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 | 2140746 | TX | Primary |
Addresses
Primary practice location
871 Old Alice Rd Ste 100
Brownsville, TX 78520-8269
Mailing address
3813 Mynah Ave
McAllen, TX 78504-5905
Phone (956) 533-1746
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 |
|---|---|---|---|
| 2140746 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533600000000",
"number": "1376022798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3813 MYNAH AVE",
"city": "MCALLEN",
"state": "TX",
"postal_code": "785045905",
"telephone_number": "956-533-1746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "871 OLD ALICE RD STE 100",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785208269",
"telephone_number": "956-554-0006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VISTA",
"first_name": "RIDGE",
"middle_name": "THEO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-07",
"last_updated": "2018-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2140746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brownsville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.