Active NPI
Susan Elaine Gandy Davis, PT
- Orthopedic Physical Therapist
- Paris, TX
National Provider Identifier
1699715367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 1032613
- Practice address
- 4005 Lamar Avenue
Paris, TX 75462 - Phone
- (903) 785-3861
- Fax
- (903) 739-8768
- NPI assigned
- Jun 8, 2006
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1032613 | TX | |
| Hand Physical Therapist | 2251H1200X | 1032613 | TX | |
| Sports Physical Therapist | 2251S0007X | 1032613 | TX | |
| Orthopedic Physical Therapist | 2251X0800X | 1032613 | TX | Primary |
Addresses
Primary practice location
4005 Lamar Avenue
Paris, TX 75462
Mailing address
4005 Lamar Avenue
Paris, TX 75462
Phone (903) 785-3861
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120492 | Other | SUPERIOR PROVIDER NUMBER | |
| 80811T | Other | TX | BCBS PROVIDER NUMBER |
| 100672030B | Medicaid | OK | |
| 058541601 | Medicaid | TX | |
| 7032430 | Other | AETNA PROVIDER NUMBER |
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 |
|---|---|---|---|
| 1032613 | TX | MD | Sports Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437177600000",
"number": "1699715367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 LAMAR AVENUE",
"city": "PARIS",
"state": "TX",
"postal_code": "75462",
"telephone_number": "903-785-3861",
"fax_number": "903-739-8768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 LAMAR AVENUE",
"city": "PARIS",
"state": "TX",
"postal_code": "75462",
"telephone_number": "903-785-3861",
"fax_number": "903-739-8768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "SUSAN",
"middle_name": "ELAINE GANDY",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-08",
"last_updated": "2015-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1032613",
"primary": false
},
{
"code": "2251H1200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Hand",
"state": "TX",
"license": "1032613",
"primary": false
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "TX",
"license": "1032613",
"primary": false
},
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "TX",
"license": "1032613",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SUPERIOR PROVIDER NUMBER",
"identifier": "120492",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "80811T",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100672030B",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "058541601",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER NUMBER",
"identifier": "7032430",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Paris, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.