Individual provider Active NPI

Kristen Johanna Ebersberger, PTA

  • Physical Therapy Assistant
  • Coral Springs, FL
National Provider Identifier
1740290576
Registry record updated May 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA25253 Issued in FL
Practice address
12126 NW 82ND St
Coral Springs, FL 33076-3412
Phone
(410) 375-7491
NPI assigned
Aug 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2306601794 VA
Physical Therapy Assistant 225200000X PTA25253 FL Primary

Addresses

Primary practice location

12126 NW 82ND St
Coral Springs, FL 33076-3412

Mailing address

12126 NW 82ND St
Coral Springs, FL 33076-3412
Phone (410) 375-7491

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
PTA25253FLMDPhysical Therapy Assistant
2306601794VAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430438400000",
    "number": "1740290576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12126 NW 82ND ST",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330763412",
            "telephone_number": "410-375-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12126 NW 82ND ST",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330763412",
            "telephone_number": "410-375-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERSBERGER",
        "first_name": "KRISTEN",
        "middle_name": "JOHANNA",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2015-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306601794",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA25253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coral Springs, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.