Active NPI
Omar Rene Baeza, PTA
- Physical Therapy Assistant
- Kingwood, TX
National Provider Identifier
1154801900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2105345
- Practice address
- 4122 Echo Mountain Dr
Kingwood, TX 77345-2074 - Phone
- (737) 216-2977
- NPI assigned
- Aug 20, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 2105345 | TX | Primary |
Addresses
Primary practice location
4122 Echo Mountain Dr
Kingwood, TX 77345-2074
Mailing address
4122 Echo Mountain Dr
Kingwood, TX 77345-2074
Phone (737) 216-2977
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 |
|---|---|---|---|
| 2105345 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710201600000",
"number": "1154801900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4122 ECHO MOUNTAIN DR",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773452074",
"telephone_number": "737-216-2977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4122 ECHO MOUNTAIN DR",
"city": "KINGWOOD",
"state": "TX",
"postal_code": "773452074",
"telephone_number": "737-216-2977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAEZA",
"first_name": "OMAR",
"middle_name": "RENE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-20",
"last_updated": "2024-03-12",
"certification_date": "2024-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2105345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingwood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.