Active NPI
Bradley Roe, DPT
- Pediatric Physical Therapist
- Springfield, TN
National Provider Identifier
1487320180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 13844
- Practice address
- 514 S Brown St
Springfield, TN 37172-2937 - Phone
- (615) 988-4552
- NPI assigned
- Aug 22, 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 13844 | TN | Primary |
Addresses
Primary practice location
514 S Brown St
Springfield, TN 37172-2937
Mailing address
PO Box 1637
Springfield, TN 37172-1637
Phone (615) 988-4552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13844 | Other | TN | STATE LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | shinepediatrictherapy.com | Direct |
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 |
|---|---|---|---|
| 13844 | TN | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shine Pediatric Therapy | Pediatrics | 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": "1629590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629590400000",
"number": "1487320180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1637",
"city": "SPRINGFIELD",
"state": "TN",
"postal_code": "371721637",
"telephone_number": "615-988-4552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 S BROWN ST",
"city": "SPRINGFIELD",
"state": "TN",
"postal_code": "371722937",
"telephone_number": "615-988-4552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROE",
"first_name": "BRADLEY",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-22",
"last_updated": "2021-08-22",
"certification_date": "2021-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TN",
"license": "13844",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "13844",
"state": "TN"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "shinepediatrictherapy.com",
"affiliation": "N",
"endpointDescription": "secure email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "514 S Brown St",
"city": "Springfield",
"state": "TN",
"country_code": "US",
"postal_code": "371722937",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Springfield, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.