Active NPI
Roosevelt Williams Jr., PTA
- Physical Therapy Assistant
- Long Beach, CA
National Provider Identifier
1386973436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3642
- Practice address
- 6444 East Spring St
# 247
Long Beach, CA 90810 - Phone
- (323) 945-4906
- NPI assigned
- Dec 21, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | 3642 | CA | Primary |
Addresses
Primary practice location
6444 East Spring St
# 247
Long Beach, CA 90810
Mailing address
1900 West Lincoln St
Long Beach, CA 90810
Phone (323) 945-4906
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 |
|---|---|---|---|
| 3642 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261353600000",
"number": "1386973436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 WEST LINCOLN ST",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90810",
"telephone_number": "323-945-4906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6444 EAST SPRING ST",
"address_2": "# 247",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90810",
"telephone_number": "323-945-4906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "ROOSEVELT",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-21",
"last_updated": "2009-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "3642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.