Active NPI
Randy Lee Roberts, LPTA
- Physical Therapy Assistant
- Kalamazoo, MI
National Provider Identifier
1568893147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502002106
- Practice address
- 2575 N Drake Rd
Kalamazoo, MI 49006-1358 - Phone
- (269) 342-0206
- NPI assigned
- Dec 6, 2013
- 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 | 5502002106 | MI | Primary |
Addresses
Primary practice location
2575 N Drake Rd
Kalamazoo, MI 49006-1358
Mailing address
2575 N Drake Rd
Kalamazoo, MI 49006-1358
Phone (269) 342-0206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5502002106 | Other | MI | MICHIGAN LICENSE |
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 |
|---|---|---|---|
| 5502002106 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386288000000",
"number": "1568893147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2575 N DRAKE RD",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490061358",
"telephone_number": "269-342-0206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2575 N DRAKE RD",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490061358",
"telephone_number": "269-342-0206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "RANDY",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "LPTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-12-06",
"last_updated": "2013-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502002106",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGAN LICENSE",
"identifier": "5502002106",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.