Active NPI
Kim Marie Laird, ATP, PTA
- Other Technician
- Tyler, TX
National Provider Identifier
1861619801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 401 E Front St Ste 224
Tyler, TX 75702-8250 - Phone
- (903) 574-3337
- NPI assigned
- Apr 19, 2007
- 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 | 2060503 | TX | |
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
401 E Front St Ste 224
Tyler, TX 75702-8250
Mailing address
5207 Old Mooringsport Rd
Shreveport, LA 71107-2810
Phone (318) 347-3390
Other practice location 1
Rt. 1 Box 725 HWY 96 South
San Augustine, TX 75972
Phone (936) 275-2900
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 |
|---|---|---|---|
| 2060503 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648684800000",
"number": "1861619801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5207 OLD MOORINGSPORT RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711072810",
"telephone_number": "318-347-3390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 E FRONT ST STE 224",
"city": "TYLER",
"state": "TX",
"postal_code": "757028250",
"telephone_number": "903-574-3337"
}
],
"practiceLocations": [
{
"address_1": "Rt. 1 Box 725 HWY 96 South",
"address_purpose": "LOCATION",
"city": "San Augustine",
"state": "TX",
"postal_code": "75972",
"country_code": "US",
"telephone_number": "936-275-2900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LAIRD",
"first_name": "KIM",
"middle_name": "MARIE",
"credential": "ATP, PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-19",
"last_updated": "2022-03-31",
"certification_date": "2022-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2060503",
"primary": false
},
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.