Active NPI
Creighton Ikeda
- Physical Therapy Assistant
- Ft. Sam Houston, TX
National Provider Identifier
1477216406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2148938
- Practice address
- 3100 Schofield Rd.
BLDG 1179, Room 1CC5
Ft. Sam Houston, TX 78234 - Phone
- (210) 808-2228
- NPI assigned
- Oct 17, 2021
- 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 | 2148938 | TX | Primary |
Addresses
Primary practice location
3100 Schofield Rd.
BLDG 1179, Room 1CC5
Ft. Sam Houston, TX 78234
Mailing address
3100 Schofield Rd.
BLDG 1179, Room 1CC5
Ft. Sam Houston, TX 78234
Phone (210) 808-2228
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 |
|---|---|---|---|
| 2148938 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634428800000",
"number": "1477216406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 SCHOFIELD RD.",
"address_2": "BLDG 1179, ROOM 1CC5",
"city": "FT. SAM HOUSTON",
"state": "TX",
"postal_code": "78234",
"telephone_number": "210-808-2228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 SCHOFIELD RD.",
"address_2": "BLDG 1179, ROOM 1CC5",
"city": "FT. SAM HOUSTON",
"state": "TX",
"postal_code": "78234",
"telephone_number": "210-808-2228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IKEDA",
"first_name": "CREIGHTON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-17",
"last_updated": "2021-10-17",
"certification_date": "2021-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2148938",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft. Sam Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.