Active NPI
Madisson Shea Damstra, PTA
- Physical Therapy Assistant
- Granbury, TX
National Provider Identifier
1831670298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2122225
- Practice address
- 801 Calinco Dr
Granbury, TX 76048-4000 - Phone
- (817) 505-7833
- Fax
- (479) 595-0581
- NPI assigned
- Aug 23, 2018
- Last updated
- Jan 2, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2122225 | TX | Primary |
Addresses
Primary practice location
801 Calinco Dr
Granbury, TX 76048-4000
Mailing address
7311 E Stone Hill CT
Lipan, TX 76462-6800
Phone (817) 226-8323
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 |
|---|---|---|---|
| 2122225 | TX | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Counseling by Penny | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Professional Counselor
- Granbury, TX
- NPI 1053723551
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704153600000",
"number": "1831670298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7311 E STONE HILL CT",
"city": "LIPAN",
"state": "TX",
"postal_code": "764626800",
"telephone_number": "817-226-8323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 CALINCO DR",
"city": "GRANBURY",
"state": "TX",
"postal_code": "760484000",
"telephone_number": "817-505-7833",
"fax_number": "479-595-0581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAMSTRA",
"first_name": "MADISSON",
"middle_name": "SHEA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-23",
"last_updated": "2024-01-02",
"certification_date": "2024-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2122225",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granbury, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.