Individual
OM GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1000 US HIGHWAY 82 E, SHERMAN, TX 75090-1704
(903) 893-9636
Mailing address
1000 US HIGHWAY 82 E, SHERMAN, TX 75090-1704
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2069440
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2069440
TEXAS PT BOARD
TX
Enumeration date
11/15/2019
Last updated
11/15/2019
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