Active NPI
Tristan Alexander Hekhuis, PTA
- Physical Therapy Assistant
- Medford, OR
National Provider Identifier
1942733001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 09364
- Practice address
- 3512 Excel Dr Ste 105
Medford, OR 97504-9850 - Phone
- (541) 245-0419
- Fax
- (541) 245-0426
- NPI assigned
- Apr 6, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 09364 | OR | Primary |
Addresses
Primary practice location
3512 Excel Dr Ste 105
Medford, OR 97504-9850
Mailing address
8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217
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 |
|---|---|---|---|
| 09364 | OR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491436800000",
"number": "1942733001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8823 PRODUCTION LN",
"city": "OOLTEWAH",
"state": "TN",
"postal_code": "373636511",
"telephone_number": "423-238-7217",
"fax_number": "423-238-3473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3512 EXCEL DR STE 105",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975049850",
"telephone_number": "541-245-0419",
"fax_number": "541-245-0426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEKHUIS",
"first_name": "TRISTAN",
"middle_name": "ALEXANDER",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-04-06",
"last_updated": "2017-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OR",
"license": "09364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.