Basic Information
| Provider Information | |||||||||
| NPI: | 1114291150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANDY | ||||||||
| FirstName: | PHILLIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761041017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173352583 | ||||||||
| FaxNumber: | 8175463672 | ||||||||
| Practice Location | |||||||||
| Address1: | 1710 COUNTRY CLUB DR | ||||||||
| Address2: | 102 | ||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760632623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177796955 | ||||||||
| FaxNumber: | 8174739963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2012 | ||||||||
| LastUpdateDate: | 03/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 11106 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.