Greg Gatzke
Individual provider Active NPI Physical Therapy Assistant · Diboll, TX
NPI 1306404017 · NPPES record last updated May 29, 2019
Key facts
- NPI
- 1306404017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2109776 (TX)
- Practice address
- 900 S Temple Dr
Diboll, TX 75941-2725 - Phone
- (877) 252-4469
- NPI assigned
- May 29, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2109776 | TX | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2109776 | TX | Yes |
Addresses
Primary practice location
900 S Temple Dr
Diboll, TX 75941-2725
Mailing address
2515 Sophie LN # 2
Nacogdoches, TX 75964-1453
Phone (936) 697-3359
Other providers in Diboll, TX
- Diboll Dental PLLC
- Diboll Independent School District
- Shannon Lacey Doherty
- Rashida Oleta Freeman
- John Carr Fullerton IV
- Taylor Gollrad
- Robin Cary Harville
- Karen Lee Henries
- Karina Itzel Hernandez
- Patsy Jackson
All providers in Diboll, TX · Physical Therapy Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.