Active NPI
Gary Danielson, ATC/R
- Rehabilitation Practitioner
- Odessa, TX
National Provider Identifier
1255799425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- AT6549
- Practice address
- 4901 E University Blvd
Odessa, TX 79762-8122 - Phone
- (432) 552-2679
- NPI assigned
- Feb 3, 2016
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | AT6549 | TX | Primary |
Addresses
Primary practice location
4901 E University Blvd
Odessa, TX 79762-8122
Mailing address
4001 Faudree Rd
Apt. D203
Odessa, TX 79765-8620
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 |
|---|---|---|---|
| AT6549 | TX | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454457600000",
"number": "1255799425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4001 FAUDREE RD",
"address_2": "APT. D203",
"city": "ODESSA",
"state": "TX",
"postal_code": "797658620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 E UNIVERSITY BLVD",
"city": "ODESSA",
"state": "TX",
"postal_code": "797628122",
"telephone_number": "432-552-2679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIELSON",
"first_name": "GARY",
"credential": "ATC/R",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-03",
"last_updated": "2016-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "TX",
"license": "AT6549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.