Active NPI
Christopher Richard Roy, PTA
- Physical Therapy Assistant
- Pearl, MS
National Provider Identifier
1972859312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4271
- Practice address
- 210 Village CV
Pearl, MS 39208-9498 - Phone
- (601) 622-3560
- NPI assigned
- Aug 2, 2012
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 42621 | AL | |
| Physical Therapy Assistant | 225200000X | 4271 | MS | Primary |
| Physical Therapy Assistant | 225200000X | 2088128 | TX |
Addresses
Primary practice location
210 Village CV
Pearl, MS 39208-9498
Mailing address
210 Village CV
Pearl, MS 39208-9498
Phone (601) 622-3560
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42621 | Other | AL | ALABAMA STATE BOARD |
| 4271 | Other | MS | MISSISSIPPI STATE BOARD |
| 2088128 | Other | TX | TEXAS STATE BOARD |
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 |
|---|---|---|---|
| 42621 | AL | MD | Physical Therapy Assistant |
| 4271 | MS | MD | Physical Therapy Assistant |
| 2088128 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343865600000",
"number": "1972859312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 VILLAGE CV",
"city": "PEARL",
"state": "MS",
"postal_code": "392089498",
"telephone_number": "601-622-3560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 VILLAGE CV",
"city": "PEARL",
"state": "MS",
"postal_code": "392089498",
"telephone_number": "601-622-3560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROY",
"first_name": "CHRISTOPHER",
"middle_name": "RICHARD",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-02",
"last_updated": "2012-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AL",
"license": "42621",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MS",
"license": "4271",
"primary": true
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2088128",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALABAMA STATE BOARD",
"identifier": "42621",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSISSIPPI STATE BOARD",
"identifier": "4271",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS STATE BOARD",
"identifier": "2088128",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pearl, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.