Active NPI
Stephen William Havard, PTA
- Physical Therapy Assistant
- Winnsboro, TX
National Provider Identifier
1417438003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2081360
- Practice address
- 406 S Main St
Winnsboro, TX 75494-3226 - Phone
- (903) 342-2310
- Fax
- (903) 342-6796
- NPI assigned
- Aug 22, 2018
- Sex
- Male
- 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 Therapy Assistant | 225200000X | 2081360 | TX | Primary |
Addresses
Primary practice location
406 S Main St
Winnsboro, TX 75494-3226
Mailing address
4116 Concord PL
Texarkana, TX 75503-0995
Phone (870) 310-1616
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2081360 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534896000000",
"number": "1417438003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4116 CONCORD PL",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755030995",
"telephone_number": "870-310-1616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 S MAIN ST",
"city": "WINNSBORO",
"state": "TX",
"postal_code": "754943226",
"telephone_number": "903-342-2310",
"fax_number": "903-342-6796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVARD",
"first_name": "STEPHEN",
"middle_name": "WILLIAM",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-22",
"last_updated": "2018-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2081360",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winnsboro, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.