Active NPI
Raymond Lee Roberts, PTA
- Physical Therapy Assistant
- Smyrna, TN
National Provider Identifier
1447503289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2736
- Practice address
- 200 Mayfield Dr
Smyrna, TN 37167-3019 - Phone
- (615) 355-0350
- NPI assigned
- Oct 17, 2012
- 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 | 2736 | TN | Primary |
Addresses
Primary practice location
200 Mayfield Dr
Smyrna, TN 37167-3019
Mailing address
217 Four Season Dr
Murfreesboro, TN 37129-8922
Phone (615) 516-7097
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 |
|---|---|---|---|
| 2736 | TN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350432000000",
"number": "1447503289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 FOUR SEASON DR",
"city": "MURFREESBORO",
"state": "TN",
"postal_code": "371298922",
"telephone_number": "615-516-7097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MAYFIELD DR",
"city": "SMYRNA",
"state": "TN",
"postal_code": "371673019",
"telephone_number": "615-355-0350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "RAYMOND",
"middle_name": "LEE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-17",
"last_updated": "2012-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "2736",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smyrna, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.