Self Richard Dba

Primary specialty

Private VehicleTaxonomy code 347C00000X

License

09332825 Issued in TX

Legal business name

SELF RICHARD DBA

Practice address

6701 Calmont Ave Apt 101
Fort Worth, TX 76116-4239

Phone

(817) 304-2892

Fax

(817) 246-4764

NPI assigned

Aug 17, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Richard Ray Baker Sr.

Title

Home Health Nurse Aide

Phone

(817) 304-8292

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218931200000",
    "number": "1003062472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 CALMONT AVE APT 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761164239",
            "telephone_number": "817-304-2892",
            "fax_number": "817-246-4764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 CALMONT AVE APT 101",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761164239",
            "telephone_number": "817-304-2892",
            "fax_number": "817-246-4764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF RICHARD DBA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-17",
        "last_updated": "2008-08-17",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "HOME HEALTH NURSE AIDE",
        "authorized_official_telephone_number": "817-304-8292",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "TX",
            "license": "09332825",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "TX",
            "license": "09332825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Thomas Selby, D.O.
• Stacey Selby, M.ED., LPC
• Select Ambulatory Surgery Center of Ft Worth LLC
• Select Physical Therapy Holdings, Inc.
• Select Physical Therapy Texas Limited Partnership
• Angela Donna Self, MD
• Kinzi Lea Self, APRN, AGACNP-BC
• Lana Self, LPC
• Matthew Thomas Seliga, DPT
• Christina Sellers, M.S. CCC-SLP

• Private Vehicle in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Private Vehicle in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.