Active NPI
Kevin Wayne Pridmore, P.T.
- Physical Therapist
- Ripley, TN
National Provider Identifier
1639393283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6702
- Practice address
- 326 Asbury Ave
Ripley, TN 38063-5577 - Phone
- (731) 221-2478
- Fax
- (731) 221-2255
- NPI assigned
- Apr 13, 2007
- 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 Therapist | 225100000X | 6702 | TN | Primary |
Addresses
Primary practice location
326 Asbury Ave
Ripley, TN 38063-5577
Mailing address
5419 Portersville Rd
Atoka, TN 38004-7331
Phone (901) 840-2359
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 |
|---|---|---|---|
| 6702 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639393283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5419 PORTERSVILLE RD",
"city": "ATOKA",
"state": "TN",
"postal_code": "380047331",
"telephone_number": "901-840-2359",
"fax_number": "731-221-2255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "326 ASBURY AVE",
"city": "RIPLEY",
"state": "TN",
"postal_code": "380635577",
"telephone_number": "731-221-2478",
"fax_number": "731-221-2255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRIDMORE",
"first_name": "KEVIN",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "6702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ripley, TN
- Northwest Tennessee Foot Clinic, PLLC
- J W Nunn
- Melissa Olds Ozment, RN
- Thomas Ross Patterson, DDS
- Paige S Pettit, R.N.
- Professional Care Services of West TN Inc
- Professional Care Services of West TN Inc (WM F Walker Counseling Center)
- Jessica Revelle Rains, PHYSICIAN ASSISTANT
- Reese Private Care Inc
- Brenda Renea Reese
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.