Edward Eugene House III, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA3784 Issued in AR

Practice address

905 Fuller Ave # C
Pocola, OK 74902-2212

Phone

(479) 719-5915

NPI assigned

Feb 5, 2025

Last updated

Feb 5, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1738713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1154135697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 FULLER AVE # C",
            "city": "POCOLA",
            "state": "OK",
            "postal_code": "749022212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 FULLER AVE # C",
            "city": "POCOLA",
            "state": "OK",
            "postal_code": "749022212",
            "telephone_number": "479-719-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOUSE",
        "first_name": "EDWARD",
        "middle_name": "EUGENE",
        "name_suffix": "III",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-05",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA3784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Thomas Coulbourn, M.A., LPC (UNDER SU)
• Amber Dawn Denney
• Karsyn Derby
• Martina Galvan
• Haisten Enterprises PC
• Jump Start Pediatric Therapy LLC
• Kal Home Health Inc
• Hope Pauline Lockhart, DC
• Pocola Family Clinic
• Pocola Nursing Center LLC

• Physical Therapy Assistant in Pocola, OK
• Providers in Pocola, OK by specialty
• Physical Therapy Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.