Active NPI
Angi Renee Varner, PTA
- Physical Therapy Assistant
- East Moline, IL
National Provider Identifier
1841567005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.003734
- Practice address
- 4343 Kennedy Dr
East Moline, IL 61244-4203 - Phone
- (309) 796-6600
- NPI assigned
- Nov 16, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 00773 | IA | |
| Physical Therapy Assistant | 225200000X | 160.003734 | IL | Primary |
Addresses
Primary practice location
4343 Kennedy Dr
East Moline, IL 61244-4203
Mailing address
4560 SE International Way
Ste. 100
Milwaukie, OR 97222
Phone (971) 206-5200
Other practice location 1
1130 West 53rd Street
Davenport, IA 52806
Phone (563) 391-5342
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160.003734 | Other | IL | PTA LICENSE |
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 |
|---|---|---|---|
| 00773 | IA | MD | Physical Therapy Assistant |
| 160.003734 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601251200000",
"number": "1841567005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY",
"address_2": "STE. 100",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97222",
"telephone_number": "971-206-5200",
"fax_number": "971-206-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4343 KENNEDY DR",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612444203",
"telephone_number": "309-796-6600"
}
],
"practiceLocations": [
{
"address_1": "1130 West 53rd Street",
"address_purpose": "LOCATION",
"city": "Davenport",
"state": "IA",
"postal_code": "52806",
"country_code": "US",
"telephone_number": "563-391-5342",
"fax_number": "971-206-5203",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VARNER",
"first_name": "ANGI",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-16",
"last_updated": "2020-09-28",
"certification_date": "2020-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IA",
"license": "00773",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.003734",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE",
"identifier": "160.003734",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.