MEDICARE: THE GREAT AM GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1528793015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GREAT AM GROUP, INC.

Provider Business Mailing Address
First Line	:	8401 BOULEVARD 26 STE 14
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5811
Country	:	US
Telephone Number	:	817-898-8444
Fax Number	:	817-886-0504

Provider Business Practice Location Address
First Line	:	8401 BOULEVARD 26 STE 14
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-5811
Country	:	US
Telephone Number	:	817-898-8444
Fax Number	:

Authorized Official
Title or Position	:	TREASURER/SECRETARY
Name	:	APRIL MARTIN
Credential	:
Telephone Number	:	817-898-8444

Provider Enumeration Date	:	07/19/2022
Last Update Date	:	08/24/2022

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