Active NPI
Andrea Lyn Holrath, PTA
- Physical Therapy Assistant
- Tyler, TX
National Provider Identifier
1598950487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2063450
- Practice address
- 4317 Park PL
Tyler, TX 75703-1883 - Phone
- (903) 649-3433
- NPI assigned
- Sep 13, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2063450 | TX | Primary |
Addresses
Primary practice location
4317 Park PL
Tyler, TX 75703-1883
Mailing address
4317 Park PL
Tyler, TX 75703-1883
Phone (903) 649-3433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2063450 | Other | TX | PTA 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 |
|---|---|---|---|
| 2063450 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189641600000",
"number": "1598950487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4317 PARK PL",
"city": "TYLER",
"state": "TX",
"postal_code": "757031883",
"telephone_number": "903-649-3433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4317 PARK PL",
"city": "TYLER",
"state": "TX",
"postal_code": "757031883",
"telephone_number": "903-649-3433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLRATH",
"first_name": "ANDREA",
"middle_name": "LYN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-13",
"last_updated": "2007-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2063450",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE #",
"identifier": "2063450",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.