East Texas Pediatric Therapy

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

EAST TEXAS PEDIATRIC THERAPY

Practice address

1738 VZCR 3103
Edgewood, TX 75117-5020

Phone

(214) 336-2248

Fax

(972) 534-1881

NPI assigned

Mar 25, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Dawn M Gober, PTA

Title

Owner/Pta

Phone

(214) 336-2248

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1740422575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1738 VZCR 3103",
            "city": "EDGEWOOD",
            "state": "TX",
            "postal_code": "751175020",
            "telephone_number": "214-336-2248",
            "fax_number": "972-534-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 VZCR 3103",
            "city": "EDGEWOOD",
            "state": "TX",
            "postal_code": "751175020",
            "telephone_number": "214-336-2248",
            "fax_number": "972-534-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "GOBER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PTA",
        "authorized_official_telephone_number": "214-336-2248",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bulldog Pharmacy, LLC
• Thomas Chapmond, LCDC
• Yvonne Carol Dixon, LVN
• Tiffany Dunn, MS,CCC/SLP
• East Texas Out-Patient PLLC
• Edgewood Drug Inc
• Edgewood Isd
• Edgewood Rural Healthh Clinic
• Gober LLC
• Edith Head, PT

• Contractor in Edgewood, TX
• Providers in Edgewood, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; 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.