Active NPI
Rosanne Petricca Medlin, P.T.
- Physical Therapist
- Granbury, TX
National Provider Identifier
1407058720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1146460
- Practice address
- 5310 Acton Hwy
Ste. 106
Granbury, TX 76049-3105 - Phone
- (817) 326-1375
- Fax
- (817) 326-2068
- NPI assigned
- May 31, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1146460 | TX | Primary |
Addresses
Primary practice location
5310 Acton Hwy
Ste. 106
Granbury, TX 76049-3105
Mailing address
2002 N Wood Duck CT
Granbury, TX 76049-5571
Phone (214) 566-5121
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1146460 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274832000000",
"number": "1407058720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 N WOOD DUCK CT",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760495571",
"telephone_number": "214-566-5121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5310 ACTON HWY",
"address_2": "STE. 106",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760493105",
"telephone_number": "817-326-1375",
"fax_number": "817-326-2068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLIN",
"first_name": "ROSANNE",
"middle_name": "PETRICCA",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2010-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1146460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.