Active NPI
Jennifer Knickerbocker, PTA
- Physical Therapy Assistant
- Lewisburg, TN
National Provider Identifier
1730236969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 821
- Practice address
- 1653 Mooresville Hwy
Lewisburg, TN 37091-2005 - Phone
- (931) 359-4506
- NPI assigned
- Jan 3, 2007
- Last updated
- Jul 8, 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 | 821 | TN | Primary |
Addresses
Primary practice location
1653 Mooresville Hwy
Lewisburg, TN 37091-2005
Mailing address
2816 Bloomfield Dr
Thompsons Station, TN 37179-5108
Phone (615) 794-8088
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 |
|---|---|---|---|
| 821 | TN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730236969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2816 BLOOMFIELD DR",
"city": "THOMPSONS STATION",
"state": "TN",
"postal_code": "371795108",
"telephone_number": "615-794-8088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1653 MOORESVILLE HWY",
"city": "LEWISBURG",
"state": "TN",
"postal_code": "370912005",
"telephone_number": "931-359-4506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNICKERBOCKER",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TN",
"license": "821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewisburg, TN
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.