Alyssa Gardner, PTA

Key facts

NPI

1841964145

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

A04234 (KY)

Practice address

6301 Bass Rd
Prospect, KY 40059-9384

Phone

(812) 508-1660

NPI assigned

Aug 2, 2021

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 2, 2021.

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1841964145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 STATE ROAD 60 W",
            "city": "MITCHELL",
            "state": "IN",
            "postal_code": "474465601",
            "telephone_number": "812-508-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 BASS RD",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599384",
            "telephone_number": "812-508-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "ALYSSA",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06006260A",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KY",
            "license": "A04234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Prospect, KY · Physical Therapy Assistant in Kentucky