Active NPI
Dipendra Gautam
- Geriatric Physical Therapist
- Madera, CA
National Provider Identifier
1437879624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT298252
- Practice address
- 502 Traverse Dr S
Madera, CA 93636 - Phone
- (703) 626-9334
- NPI assigned
- Aug 30, 2022
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT298252 | CA | Primary |
Addresses
Primary practice location
502 Traverse Dr S
Madera, CA 93636
Mailing address
7942 N Maple Ave Ste 102
Fresno, CA 93720-0293
Phone (595) 396-4681
Other practice location 1
113 RIverwalk Blvd S
Suite 111-50
Madera, CA 93636
Phone (703) 626-9334
Other practice location 2
7942 N Maple Ave Ste 102
Fresno, CA 93720-0293
Phone (595) 396-4681
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | health | Direct |
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 |
|---|---|---|---|
| PT298252 | CA | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749340800000",
"number": "1437879624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7942 N MAPLE AVE STE 102",
"city": "FRESNO",
"state": "CA",
"postal_code": "937200293",
"telephone_number": "595-396-4681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 TRAVERSE DR S",
"city": "MADERA",
"state": "CA",
"postal_code": "93636",
"telephone_number": "703-626-9334"
}
],
"practiceLocations": [
{
"address_1": "113 RIverwalk Blvd S",
"address_2": "Suite 111-50",
"address_purpose": "LOCATION",
"city": "Madera",
"state": "CA",
"postal_code": "93636",
"country_code": "US",
"telephone_number": "703-626-9334",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7942 N Maple Ave Ste 102",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937200293",
"country_code": "US",
"telephone_number": "595-396-4681",
"fax_number": "559-336-4484",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GAUTAM",
"first_name": "DIPENDRA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-30",
"last_updated": "2025-06-08",
"certification_date": "2025-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "CA",
"license": "PT298252",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "health",
"affiliation": "N",
"endpointDescription": "physical therapist",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "502 traverse dr S",
"city": "madera",
"state": "CA",
"country_code": "US",
"postal_code": "93636",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.