Active NPI
Preston Fenimore Gover, PTA
- Physical Therapy Assistant
- Catonsville, MD
National Provider Identifier
1063935179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A4748
- Practice address
- 715 Maiden Choice LN
Catonsville, MD 21228-5999 - Phone
- (410) 601-8869
- NPI assigned
- Jul 20, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 9980 | MA | |
| Physical Therapy Assistant | 225200000X | A4748 | MD | Primary |
Addresses
Primary practice location
715 Maiden Choice LN
Catonsville, MD 21228-5999
Mailing address
PO Box 11473
Takoma Park, MD 20913-1473
Phone (301) 945-7016
Other practice location 1
3140 Gracefield Rd
Silver Spring, MD 20904-5851
Phone (800) 917-8521
Other practice location 2
100 Alden St
Provincetown, MA 02657-1456
Phone (508) 487-7090
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 |
|---|---|---|---|
| 9980 | MA | MD | General Practice Dentistry |
| A4748 | MD | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643155200000",
"number": "1063935179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 11473",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209131473",
"telephone_number": "301-945-7016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 MAIDEN CHOICE LN",
"city": "CATONSVILLE",
"state": "MD",
"postal_code": "212285999",
"telephone_number": "410-601-8869"
}
],
"practiceLocations": [
{
"address_1": "3140 Gracefield Rd",
"address_purpose": "LOCATION",
"city": "Silver Spring",
"state": "MD",
"postal_code": "209045851",
"country_code": "US",
"telephone_number": "800-917-8521",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 Alden St",
"address_purpose": "LOCATION",
"city": "Provincetown",
"state": "MA",
"postal_code": "026571456",
"country_code": "US",
"telephone_number": "508-487-7090",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOVER",
"first_name": "PRESTON",
"middle_name": "FENIMORE",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-20",
"last_updated": "2022-01-26",
"certification_date": "2022-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "9980",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MD",
"license": "A4748",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Catonsville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.