Mary Faith Grimberg, DPT, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1210755 Issued in TX

Practice address

2519 S Lakeline Blvd
Suite 100
Cedar Park, TX 78613-2964

Phone

(512) 331-6200

Fax

(512) 331-4312

NPI assigned

Sep 29, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1317254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317254400000",
    "number": "1851675581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4330 BULL CREEK RD",
            "address_2": "APT #2419",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787315903",
            "telephone_number": "703-298-8366",
            "fax_number": "512-331-4312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 S LAKELINE BLVD",
            "address_2": "SUITE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132964",
            "telephone_number": "512-331-6200",
            "fax_number": "512-331-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIMBERG",
        "first_name": "MARY",
        "middle_name": "FAITH",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-29",
        "last_updated": "2011-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1210755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS PHYSICAL THERAPY LICENSE",
            "identifier": "TX1210755",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; 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.