512 Physical Therapy and Golf Performance Center

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

512 PHYSICAL THERAPY AND GOLF PERFORMANCE CENTER

Practice address

4425 S Mopac Expy Ste 101
Austin, TX 78735-6710

Phone

(512) 669-2162

Fax

(512) 572-3272

NPI assigned

Aug 22, 2016

Last updated

Mar 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Jerome Odell, PTNPI 1457665887

Title

Owner

Phone

(512) 699-2162

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert J. O'Dell, P.T.

  • Physical Therapist
  • Austin, TX
  • NPI 1457665887
  Medicare reassignment Care Compare group NPD Authorized official
• Kevin James Walker, MSPT

  • Physical Therapist
  • Austin, TX
  • NPI 1336308857
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1285189134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8304 ALOPHIA DR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787391999",
            "telephone_number": "512-699-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 S MOPAC EXPY STE 101",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787356710",
            "telephone_number": "512-669-2162",
            "fax_number": "512-572-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "512 PHYSICAL THERAPY AND GOLF PERFORMANCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-22",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "ODELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-699-2162",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Austin, TX
• Providers in Austin, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.