Active NPI
Johnel Vidad, PTA
- Physical Therapy Assistant
- Houston, TX
National Provider Identifier
1033639877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2060899
- Practice address
- 16820 West Rd
Houston, TX 77095-5577 - Phone
- (832) 212-0770
- NPI assigned
- Jun 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 2060899 | TX | Primary |
Addresses
Primary practice location
16820 West Rd
Houston, TX 77095-5577
Mailing address
16820 West Rd # 3
Houston, TX 77095-5577
Phone (281) 856-7008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2251500000X | Medicaid | TX |
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 |
|---|---|---|---|
| 2060899 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498176000000",
"number": "1033639877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16820 WEST RD # 3",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770955577",
"telephone_number": "281-856-7008",
"fax_number": "281-856-7108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16820 WEST RD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770955577",
"telephone_number": "832-212-0770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDAD",
"first_name": "JOHNEL",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-22",
"last_updated": "2017-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2060899",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2251500000X",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.