Jennifer Melissa Newsom, P.T.

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT 6673 Issued in SC

Practice address

120C Springhall Dr
Goose Creek, SC 29445-5335

Phone

(843) 216-0290

NPI assigned

Jul 16, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Missy Newsom Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342396800000",
    "number": "1700131802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 COUNTRY PLACE RD",
            "city": "MOUNT PLEASANT",
            "state": "SC",
            "postal_code": "294648258",
            "telephone_number": "501-339-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120C SPRINGHALL DR",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294455335",
            "telephone_number": "843-216-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWSOM",
        "first_name": "JENNIFER",
        "middle_name": "MELISSA",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "SC",
            "license": "PT 6673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5T910",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISSY",
            "last_name": "NEWSOM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pediatric Physical Therapist in Goose Creek, SC
• Providers in Goose Creek, SC by specialty
• Pediatric Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.