Active NPI
Christian Mims
- Physical Therapy Assistant
- Tyler, TX
National Provider Identifier
1972123073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2147730
- Practice address
- 900 S Baxter Ave
Tyler, TX 75701-2209 - Phone
- (903) 312-3310
- NPI assigned
- Apr 20, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2147730 | TX | Primary |
Addresses
Primary practice location
900 S Baxter Ave
Tyler, TX 75701-2209
Mailing address
16531 Janan Dr
Tyler, TX 75707-7629
Phone (903) 312-3310
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | chrissymims@gmail.com | Other |
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 |
|---|---|---|---|
| 2147730 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696291200000",
"number": "1972123073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16531 JANAN DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757077629",
"telephone_number": "903-312-3310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 S BAXTER AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757012209",
"telephone_number": "903-312-3310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIMS",
"first_name": "CHRISTIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-20",
"last_updated": "2023-10-03",
"certification_date": "2023-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2147730",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "chrissymims@gmail.com",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "bussiness emails and personal emails",
"address_1": "900 S Baxter Ave",
"city": "Tyler",
"state": "TX",
"country_code": "US",
"postal_code": "757012209",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.