Active NPI
Lisa A Weathers, PT
- Sports Physical Therapist
- Greenville, MS
National Provider Identifier
1598085730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- License
- PT4686
- Practice address
- 1707 S Colorado St
Suite a
Greenville, MS 38703-7275 - Phone
- (662) 335-8332
- Fax
- (662) 335-8852
- NPI assigned
- Jun 10, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | PT4686 | MS | Primary |
Addresses
Primary practice location
1707 S Colorado St
Suite a
Greenville, MS 38703-7275
Mailing address
1707 S Colorado St
Suite a
Greenville, MS 38703-7275
Phone (662) 335-8332
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09015486 | Medicaid | MS | |
| 640925683 | Other | MS | BCBS |
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 |
|---|---|---|---|
| PT4686 | MS | MD | Sports Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River City Rehabilitation LLC | Sports | 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": "1276128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276128000000",
"number": "1598085730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 S COLORADO ST",
"address_2": "SUITE A",
"city": "GREENVILLE",
"state": "MS",
"postal_code": "387037275",
"telephone_number": "662-335-8332",
"fax_number": "662-335-8852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1707 S COLORADO ST",
"address_2": "SUITE A",
"city": "GREENVILLE",
"state": "MS",
"postal_code": "387037275",
"telephone_number": "662-335-8332",
"fax_number": "662-335-8852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEATHERS",
"first_name": "LISA",
"middle_name": "A",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-10",
"last_updated": "2010-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "MS",
"license": "PT4686",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09015486",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "640925683",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.