Alex Kenneth Gottleaber, ATP

Primary specialty

Other TechnicianTaxonomy code 247200000X

License

91528 Issued in TX

Practice address

1101 W Vickery Blvd
Fort Worth, TX 76104-1025

Phone

(682) 885-6294

Fax

(682) 885-1135

NPI assigned

Aug 9, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cook Childrens Home Health

  • Durable Medical Equipment & Medical Supplies
  • Fort Worth, TX
  • NPI 1801866173
  NPD (past)

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1003581455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99283",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761991383",
            "telephone_number": "682-885-6294",
            "fax_number": "682-885-1135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W VICKERY BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761041025",
            "telephone_number": "682-885-6294",
            "fax_number": "682-885-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLEABER",
        "first_name": "ALEX",
        "middle_name": "KENNETH",
        "credential": "ATP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "TX",
            "license": "91528",
            "primary": true
        },
        {
            "code": "225CA2400X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor, Assistive Technology Practitioner",
            "state": "TX",
            "license": "91528",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lica Gosdzinski, CRNA
• Goshen Family Clinic, Inc.
• Gregory W Gossman, PHARM. D.
• Jennifer Anne Gotcher, M.S. LMFT
• Sriharika Reddy Gottipolu, MD
• James H Gottlich, LCSW
• Staci Gottlieb, RN, MSN, PMHNP
• Breana Faye Gough
• Dana-Marie A Gould, DO
• David Lawrence Gould, M.D.

• Other Technician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Other Technician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.