Olivia Claire Gorham, PT, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

1335632 Issued in TX

Practice address

4402 Williams Dr Ste 115
Georgetown, TX 78628-1388

Phone

(512) 256-7627

NPI assigned

Sep 7, 2020

Last updated

Sep 7, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jacqueline Kozak

  • Occupational Medicine Clinic/Center
  • Georgetown, TX
  • NPI 1699482448
  NPD
• Allied Therapies of Texas, PLLC

  • Multi-Specialty Clinic/Center
  • Copperas Cove, TX
  • NPI 1164009254

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1599436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599436800000",
    "number": "1497369466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 LANGDALE LN",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787545510",
            "telephone_number": "832-797-2131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 WILLIAMS DR STE 115",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786281388",
            "telephone_number": "512-256-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORHAM",
        "first_name": "OLIVIA",
        "middle_name": "CLAIRE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-07",
        "last_updated": "2020-09-07",
        "certification_date": "2020-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "TX",
            "license": "1335632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE NUMBER",
            "identifier": "1335632",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janine Goodwin, RN
• Mithula Rao Gopalam
• Denise Ann Gordon, MSW
• Jonathan Gordon, NP-C
• Victoria Gorena
• Got Ur Back Chiropractic, PLLC
• Grace Anchor LLC
• Grace M Salone, OD, PLLC (Texas State Optical)
• Grace Psychiatric Services, PLLC
• Rosa Lopez Gragan

• Pediatric Physical Therapist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Pediatric Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2020; 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.