Individual provider Active NPI

Kidist Mekonnen, PTA

  • Physical Therapy Assistant
  • Houston, TX
National Provider Identifier
1720588635
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
2135929 Issued in TX
Practice address
10425 Huffmeister Rd Ste 320
Houston, TX 77065-3429
Phone
(281) 955-2650
NPI assigned
Feb 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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 2135929 TX Primary

Addresses

Primary practice location

10425 Huffmeister Rd Ste 320
Houston, TX 77065-3429

Mailing address

15826 Ironside Creek Dr
Houston, TX 77053-3413
Phone (832) 277-2555

Other practice location 1

15826 Ironside Creek Dr
Houston, TX 77053-3413
Phone (832) 277-2555

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
2135929TXMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1720588635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15826 IRONSIDE CREEK DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770533413",
            "telephone_number": "832-277-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10425 HUFFMEISTER RD STE 320",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770653429",
            "telephone_number": "281-955-2650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15826 Ironside Creek Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770533413",
            "country_code": "US",
            "telephone_number": "832-277-2555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEKONNEN",
        "first_name": "KIDIST",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-16",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2135929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.