Healthcare Provider Details

I. General information

NPI: 1497962591
Provider Name (Legal Business Name): NATHAN THOMAS GASKAMP PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14857 SOUTHWEST FWY
SUGAR LAND TX
77478
US

IV. Provider business mailing address

1514 WINSTON DR
RICHMOND TX
77469-4944
US

V. Phone/Fax

Practice location:
  • Phone: 281-242-8900
  • Fax:
Mailing address:
  • Phone: 281-232-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2060153
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: