NPIMap

Organization Active NPI

Odessa Physical Therapy PC

  • Physical Therapist
  • Odessa, TX
National Provider Identifier
1609873439
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ODESSA PHYSICAL THERAPY PC
Practice address
4407 N Grandview Ave
Odessa, TX 79762-5311
Phone
(432) 366-9541
Fax
(432) 366-1951
NPI assigned
Jul 7, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Larry Charles Feeler, PTNPI 1992716971
Title
President
Phone
(432) 366-9541

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X TX Primary

Addresses

Primary practice location

4407 N Grandview Ave
Odessa, TX 79762-5311

Mailing address

4407 N Grandview Ave
Odessa, TX 79762-5311
Phone (432) 366-9541

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040122000738 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2163324955 Receives reassigned benefits from 8 practitioners
Practice locations: Odessa, TX

National Provider Directory

National Provider Directory
Tax ID family
Odessa Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4407 N Grandview Ave
Odessa, TX 79762
Phone (432) 366-9541

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609873439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4407 N GRANDVIEW AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625311",
            "telephone_number": "432-366-9541",
            "fax_number": "432-366-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4407 N GRANDVIEW AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625311",
            "telephone_number": "432-366-9541",
            "fax_number": "432-366-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODESSA PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FEELER",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "432-366-9541",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.