Active NPI
Jessica Dyann Fambrough, PTA
- Physical Therapy Assistant
- Wylie, TX
National Provider Identifier
1578074530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2131626
- Practice address
- 611 W Brown St Ste 101
Wylie, TX 75098-5816 - Phone
- (972) 442-5287
- Fax
- (972) 442-3181
- NPI assigned
- Oct 18, 2017
- 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 Therapy Assistant | 225200000X | 2131626 | TX | Primary |
Addresses
Primary practice location
611 W Brown St Ste 101
Wylie, TX 75098-5816
Mailing address
1200 Corporate Dr Ste 400
Birmingham, AL 35242-5424
Phone (423) 238-8930
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 |
|---|---|---|---|
| 2131626 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508284800000",
"number": "1578074530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CORPORATE DR STE 400",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352425424",
"telephone_number": "423-238-8930",
"fax_number": "423-254-5217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "611 W BROWN ST STE 101",
"city": "WYLIE",
"state": "TX",
"postal_code": "750985816",
"telephone_number": "972-442-5287",
"fax_number": "972-442-3181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAMBROUGH",
"first_name": "JESSICA",
"middle_name": "DYANN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-18",
"last_updated": "2017-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2131626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wylie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.