Dustin David Long

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2148454 Issued in TX

Practice address

1010 W Main St
Henderson, TX 75652-2923

Phone

(903) 657-6513

NPI assigned

Jun 10, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1306413091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 WILLOW RD",
            "city": "HALLSVILLE",
            "state": "TX",
            "postal_code": "756506144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W MAIN ST",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "756522923",
            "telephone_number": "903-657-6513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "DUSTIN",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2148454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kroger Texas L P
• Kevin Scott Lawrence, MD
• Joosang Lee
• Cassie Ann Leonard-Pierce, LPC
• Linncare Management Corporation
• Dylan Martinez
• Donna G Mason, LPC
• Tom L McAvoy, DC
• Tamara McCann, PTA
• Jamie Rochelle McCoy, LVN

• Physical Therapy Assistant in Henderson, TX
• Providers in Henderson, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.