Individual provider Active NPI

Kristian Robinson, PTA

  • Physical Therapy Assistant
  • Collierville, TN
National Provider Identifier
1609121292
Registry record updated Jul 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA0000004004 Issued in TN
Practice address
110 N Main St
Collierville, TN 38017-2618
Phone
(901) 221-2619
Fax
(866) 380-3102
NPI assigned
Jul 19, 2012
Last updated
Jul 19, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA0000004004 TN Primary

Addresses

Primary practice location

110 N Main St
Collierville, TN 38017-2618

Mailing address

110 N Main St
Collierville, TN 38017-2618
Phone (901) 221-2619

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

LicenseStateTypeSpecialty
PTA0000004004TNMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
PT Squared, LLC PastSince Nov 10, 2012 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1609121292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N MAIN ST",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172618",
            "telephone_number": "901-221-2619",
            "fax_number": "866-380-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N MAIN ST",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172618",
            "telephone_number": "901-221-2619",
            "fax_number": "866-380-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBINSON",
        "first_name": "KRISTIAN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-19",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "PTA0000004004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collierville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.

Verify at the official NPI Registry.