Active NPI
Bryn Petty, SLP
- Speech-Language Pathologist
- Austin, TX
National Provider Identifier
1194030635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 2211 I 35 South
Suite 300
Austin, TX 78741 - Phone
- (512) 394-0652
- NPI assigned
- Aug 9, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
2211 I 35 South
Suite 300
Austin, TX 78741
Mailing address
145 Teal Lake Dr
Richmond Hill, GA 31324-3518
Phone (817) 433-0721
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149984001 | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281312000000",
"number": "1194030635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 TEAL LAKE DR",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313243518",
"telephone_number": "817-433-0721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 I 35 SOUTH",
"address_2": "SUITE 300",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78741",
"telephone_number": "512-394-0652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "BRYN",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-09",
"last_updated": "2010-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "149984001",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.