Wayne Bradshaw Fancher III, DPT, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1261465 Issued in TX

Practice address

11466 Honor LN
Tyler, TX 75708-3296

Phone

(903) 617-6150

NPI assigned

Sep 29, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1992214209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 MOUNT SYLVAN ST",
            "city": "LINDALE",
            "state": "TX",
            "postal_code": "757716234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11466 HONOR LN",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757083296",
            "telephone_number": "903-617-6150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 Pierce St",
            "address_purpose": "LOCATION",
            "city": "Lindale",
            "state": "TX",
            "postal_code": "757713335",
            "country_code": "US",
            "telephone_number": "903-881-9373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANCHER",
        "first_name": "WAYNE",
        "middle_name": "BRADSHAW",
        "name_suffix": "III",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-29",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1261465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farzad Fakouri, M.D. , MPH
• Amanda L Falbo, PMHNP
• Madison Falgout
• Family Care Sitter Services
• Family First Pharmacy LP
• Fannin County Hospital Authority
• Paul M Fanning, MD
• David Pearce Fannon, MPAS, PA-C
• Concepcion Fanous, APRN, FNP-C
• Elias I Fanous Jr., MD

• Physical Therapist in Tyler, TX
• Providers in Tyler, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.

Verify at the official NPI Registry.