Active NPI
Marissa Grooms
- Physical Therapist
- Lewisville, TX
National Provider Identifier
1750834818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1830
- Practice address
- 190 Civic Cir Ste 210
Lewisville, TX 75067-3635 - Phone
- (972) 317-4422
- NPI assigned
- Jul 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1830 | WY | Primary |
| Pediatric Physical Therapist | 2251P0200X | 3120095 | TX |
Addresses
Primary practice location
190 Civic Cir Ste 210
Lewisville, TX 75067-3635
Mailing address
PO Box 20970
Cheyenne, WY 82003-7020
Phone (307) 635-2562
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3120095 | TX | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538697600000",
"number": "1750834818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20970",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820037020",
"telephone_number": "307-635-2562",
"fax_number": "307-638-2074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 CIVIC CIR STE 210",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750673635",
"telephone_number": "972-317-4422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOMS",
"first_name": "MARISSA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-25",
"last_updated": "2018-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "WY",
"license": "1830",
"primary": true
},
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "3120095",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.