Chaundra Ja'Niece Dewberry

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2125483 Issued in TX

Practice address

404 Racquet Club Blvd
Bedford, TX 76022-6408

Phone

(682) 738-3056

Fax

(682) 738-3272

NPI assigned

Jan 18, 2018

Last updated

Jan 18, 2018By the provider in NPPES

Sex

Female

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Small Hands Big Hearts Pediatric Therapy Management Inc

  • Home Health Agency
  • Fort Worth, TX
  • NPI 1992012660
  NPD (past)

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1346758893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 LAS COLINAS BLVD E APT 4077",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750395823",
            "telephone_number": "682-472-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 RACQUET CLUB BLVD",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226408",
            "telephone_number": "682-738-3056",
            "fax_number": "682-738-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWBERRY",
        "first_name": "CHAUNDRA",
        "middle_name": "JA'NIECE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2125483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis N Dinh DMD PLLC (Live Laugh Smile Dentistry)
• Errol Derouen
• Deuteronomy
• Jonathan R. Devane, P.A.
• Madhuri Devdhar, MD
• DFW Advanced Medical
• DFW Ultrasound Associates, LLC
• Anjum Mehmood Dhamani
• Sophia Dhanani, DO
• Harish Kumar Dhingra, M.D.

• Physical Therapy Assistant in Bedford, TX
• Providers in Bedford, 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 Jan 18, 2018; 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.