DR. ITALA MANOSHA WICKREMASINGHE (NPI# 1508972050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508972050 |
| Entity Type | Individual |
| Full Name | DR. ITALA MANOSHA WICKREMASINGHE |
| Credential | MD |
| Practice Address |
4500 S Lancaster Rd Dallas TX 75216-7167 |
| Mailing Address |
8631 Clover Meadow Dr Dallas TX 75243-7626 |
| Practice Telephone | 2148571757 |
| Mailing Telephone | 2145539118 |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P0004X |
Physical Medicine & Rehabilitation Specialization: Spinal Cord Injury Medicine |
92490 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
4500 S LANCASTER RD |
| City | DALLAS |
| State | TX |
| Zip Code | 75216-7167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083608178 | Lynn Brooks | Obstetrics & Gynecology | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2005-09-06 |
| 1952909392 | Christy M Jacob | Occupational Therapist | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-10-16 |
| 1861090680 | Jennifer Michelle Dejong | Social Worker | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-10-14 |
| 1639776511 | Hanh Kimberly Nguyen | Pharmacist | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-10-05 |
| 1871190868 | Nida Khan | Pharmacist | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-10-03 |
| 1720685969 | Elizabeth Anderson | Psychologist | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-10-01 |
| 1780291104 | Regina Reynolds | Social Worker | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-09-29 |
| 1962018309 | Carl Lonell Lee | Registered Nurse | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-09-21 |
| 1407462393 | Bing Liu | Nurse Practitioner | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-09-16 |
| 1508472457 | Dana Martin | Nurse Practitioner | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2020-09-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699384115 | Dg Edwards Pllc | Clinic/Center | 4498 Marsalis Avenue, Dallas, TX 75216 | 2020-07-30 |
| 1407407984 | Margaret Ruth Mitchell | Technician | 4950 Wadsworth Apt 1019, Dallas, TX 75216 | 2019-09-25 |
| 1033605373 | James Sherman Mckoy | Radiology | 45oo S Lancaster Rd, Dallas, TX 75216 | 2018-07-10 |
| 1982192274 | Toni Danielle Smith | Pharmacist | 3232 Great Trinity Forest Way Ste 102a, Dallas, TX 75216 | 2018-04-23 |
| 1124546353 | Tiffany Price | Social Worker | 45oo S. Lancaster Rd., Dallas, TX 75216 | 2017-09-08 |
| 1215397476 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 150 East Illinois Ave, Dallas, TX 75216 | 2016-03-02 |
| 1629466834 | Elena Mayra Rodriguez | Physician Assistant | 3200 S Lancaster Rd Ste 180, Dallas, TX 75216 | 2014-12-23 |
| 1043651367 | Lakisha Henderson | Registered Nurse | 2619 S. Lancaster Rd, Dallas, TX 75216 | 2013-07-15 |
| 1669812871 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 5050 S Lancaster Rd, Dallas, TX 75216 | 2013-07-02 |
| 1922341361 | Angela S Ayers | Home Health Aide | 302 Zang Ave, Dallas, TX 75216 | 2013-04-04 |
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| Taxonomy Code | 2081P0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Spinal Cord Injury Medicine |
| A physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal cord dysfunction by working in an interdisciplinary manner. Care is provided to patients of all ages on a lifelong basis and covers related medical, physical, psychological and vocational disabilities and complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. ACGME Accredited Residency Program Requirements: 1 year of training with 3-5 years in relevant specialty for a total of 4-6 years. ABMS Approved Subspecialty Certificate: (Physical Medicine and Rehabilitation) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881822674 | Joseph Benjamin Carlock | Physical Medicine & Rehabilitation | 4500 S Lancaster Rd, Dallas, TX 75216-7167 | 2009-06-30 |
| 1780886580 | Jennifer Marie Juinio Yang | Physical Medicine & Rehabilitation | 5323 Harry Hines Blvd Dallas Tx 75390 7201, Dallas, TX 75390-7201 | 2007-06-04 |
| 1487745139 | Jon Vandeventer | Physical Medicine & Rehabilitation | 4500 South Lancaster Rd, Dallas Va - 128, Dallas, TX 75216 | 2006-09-27 |
| 1134233752 | Maria Fides M Pacheco | Physical Medicine & Rehabilitation | 4500 S Lancaster Rd, Sci Service (128), Dallas, TX 75216-7167 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598785164 | Sally Ann Holmes | Physical Medicine & Rehabilitation | 2002 Holcombe Blvd., Spinal Cord Injury Care Line (128), Houston, TX 77030 | 2006-07-19 |
| 1710935093 | David K Harris | Physical Medicine & Rehabilitation | 7307 Creekbluff Dr, Austin, TX 78750-8203 | 2006-05-05 |
| 1437617768 | Julie M Quinn | Physical Medicine & Rehabilitation | 504 Medical Center Blvd, Conroe, TX 77304-2808 | 2019-03-05 |
| 1609384213 | Pm&r Consultants, Pllc | Physical Medicine & Rehabilitation | 6441 Main St, Houston, TX 77030-1502 | 2018-01-17 |
| 1861931560 | Omni Spine Pain Management, Pllc | Physical Medicine & Rehabilitation | 4500 Hillcrest Rd, Suite 185, Frisco, TX 75035-5418 | 2017-02-15 |
| 1538477088 | Tanisha A Toaston Do Pa | Physical Medicine & Rehabilitation | 2304 Highway 121, Bedford, TX 76021-5985 | 2010-09-17 |
| 1316260979 | Center for Spine, Sports, and Rehabilitation | Physical Medicine & Rehabilitation | 2100 West Loop S, Houston, TX 77027-3515 | 2010-03-10 |
| 1629209606 | St. David's Physical Medicine and Rehabilitation, Pllc | Physical Medicine & Rehabilitation | 1015 E 32nd St, Suite 306, Austin, TX 78705-2707 | 2009-08-07 |
| 1801076617 | Michelle B. Trbovich | Physical Medicine & Rehabilitation | 7400 Merton Minter St, San Antonio, TX 78229-4404 | 2007-11-08 |
| 1497953988 | David Back Clinic of America | Physical Medicine & Rehabilitation | 3800 Hulen St, #110, Fort Worth, TX 76107-7276 | 2007-07-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.