Active NPI
Leo Tagbar Sumatra
- Geriatric Physical Therapist
- Mount Juliet, TN
National Provider Identifier
1497017578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT1965
- Practice address
- 13135 Lebanon Rd
Mount Juliet, TN 37122-2873 - Phone
- (615) 554-9224
- NPI assigned
- Jun 13, 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT1965 | TN | Primary |
Addresses
Primary practice location
13135 Lebanon Rd
Mount Juliet, TN 37122-2873
Mailing address
13135 Lebanon Rd
Mount Juliet, TN 37122-2873
Phone (615) 554-9224
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1965 | TN | MD | Health Service Psychologist |
| PT1965 | TN | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1497017578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13135 LEBANON RD",
"city": "MOUNT JULIET",
"state": "TN",
"postal_code": "371222873",
"telephone_number": "615-554-9224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13135 LEBANON RD",
"city": "MOUNT JULIET",
"state": "TN",
"postal_code": "371222873",
"telephone_number": "615-554-9224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUMATRA",
"first_name": "LEO",
"middle_name": "TAGBAR",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-13",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "TN",
"license": "PT1965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Juliet, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.