Healthcare Provider Details

I. General information

NPI: 1386978187
Provider Name (Legal Business Name): THERAPEUTIC DIMENSIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 38TH ST SUITE 400
AUSTIN TX
78705-1127
US

IV. Provider business mailing address

PO BOX 1337
SAN ANTONIO TX
78295-1337
US

V. Phone/Fax

Practice location:
  • Phone: 512-291-7250
  • Fax: 512-291-7265
Mailing address:
  • Phone: 210-824-5292
  • Fax: 210-824-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GORDON A BEARDWOOD
Title or Position: OWNER
Credential: MD
Phone: 210-824-5292