Active NPI
Austine Omeben
- Physical Therapist
- Plano, TX
National Provider Identifier
1417707233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 40QA02206200
- Practice address
- 5800 Granite Pkwy Ste 1000
Plano, TX 75024-6619 - Phone
- (561) 316-7405
- NPI assigned
- Mar 25, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 40QA02206200 | NJ | Primary |
Addresses
Primary practice location
5800 Granite Pkwy Ste 1000
Plano, TX 75024-6619
Mailing address
PO Box 487
High Springs, FL 32655-0487
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 |
|---|---|---|---|
| 40QA02206200 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725580800000",
"number": "1417707233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 487",
"city": "HIGH SPRINGS",
"state": "FL",
"postal_code": "326550487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5800 GRANITE PKWY STE 1000",
"city": "PLANO",
"state": "TX",
"postal_code": "750246619",
"telephone_number": "561-316-7405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMEBEN",
"first_name": "AUSTINE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-25",
"last_updated": "2024-09-06",
"certification_date": "2024-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA02206200",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.