Active NPI
Abraham Philip
- Physical Therapy Assistant
- Lakeway, TX
National Provider Identifier
1700460680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2159534
- Practice address
- 302 Medical Pkwy
Lakeway, TX 78738-5632 - Phone
- (210) 848-9082
- NPI assigned
- May 7, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 2159534 | TX | Primary |
Addresses
Primary practice location
302 Medical Pkwy
Lakeway, TX 78738-5632
Mailing address
6303 Sienna Ranch Rd Apt 3111
Missouri City, TX 77459-4790
Phone (845) 269-9530
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 |
|---|---|---|---|
| 2159534 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620345600000",
"number": "1700460680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6303 SIENNA RANCH RD APT 3111",
"city": "MISSOURI CITY",
"state": "TX",
"postal_code": "774594790",
"telephone_number": "845-269-9530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 MEDICAL PKWY",
"city": "LAKEWAY",
"state": "TX",
"postal_code": "787385632",
"telephone_number": "210-848-9082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILIP",
"first_name": "ABRAHAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-07",
"last_updated": "2021-05-07",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2159534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeway, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.