Active NPI
Kent Lippert, PTA
- Physical Therapy Assistant
- Jacksonville Beach, FL
National Provider Identifier
1497879969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 14121
- Practice address
- 333 1St St N
Suite 2001
Jacksonville Beach, FL 32250-6945 - Phone
- (800) 920-5038
- NPI assigned
- Mar 19, 2007
- 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 | 14121 | FL | Primary |
Addresses
Primary practice location
333 1St St N
Suite 2001
Jacksonville Beach, FL 32250-6945
Mailing address
PO Box 1154
Melbourne, FL 32902-1154
Phone (321) 848-2066
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 |
|---|---|---|---|
| 14121 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497879969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1154",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329021154",
"telephone_number": "321-848-2066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 1ST ST N",
"address_2": "SUITE 2001",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322506945",
"telephone_number": "800-920-5038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIPPERT",
"first_name": "KENT",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "14121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.