George Kenyon Exeter, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P1 60100220 Issued in WA

Practice address

817 E Plum Ave
Moses Lake, WA 98837

Phone

(509) 765-7835

NPI assigned

Nov 21, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Ken Exeter 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": "1353456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353456000000",
    "number": "1831433325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 G ST NE",
            "city": "EPHRATA",
            "state": "WA",
            "postal_code": "988231769",
            "telephone_number": "509-754-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 E PLUM AVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "98837",
            "telephone_number": "509-765-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EXETER",
        "first_name": "GEORGE",
        "middle_name": "KENYON",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-21",
        "last_updated": "2012-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P1   60100220",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "PTA-51",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEN",
            "last_name": "EXETER",
            "prefix": "MR.",
            "credential": "PTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapy Assistant in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.