TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC (NPI# 1376579797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376579797 |
| Entity Type | Organization |
| Organization Name | TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC |
| Other Organization Name | TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC |
| Practice Address |
2519 S Lakeline Blvd Suite 100 Cedar Park TX 78613-2964 |
| Practice Telephone | 5123316200 |
| Practice Fax Number | 5123314312 |
| Mailing Telephone | 5123316200 |
| Mailing Fax Number | 5123316384 |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2011-03-17 |
| Authorized Official Name | MICHAEL RAY TILLMAN (PHYICAL THERAPIST PRESIDENT) |
| Authorized Official Telephone | 5123316200 |
| Authorized Official Credential | MPT, CSCS, CERT. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | 554280000 | TX | Ambulatory Health Care Facilities |
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
644350000 | TX | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 153870401 | 05 |
| Other Name | Type Code |
|---|---|
| Tillman Physical Therapy & Sports Training Center, Inc | Former Legal Business Name - Organization |
| Street Address |
2519 S LAKELINE BLVD SUITE 100 |
| City | CEDAR PARK |
| State | TX |
| Zip Code | 78613-2964 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164468518 | Karen M Hoffman | Occupational Therapist | 2519 S Lakeline Blvd, Suite 100, Cedar Park, TX 78613-2964 | 2006-06-22 |
| 1245778463 | Justin Nykiel | Physical Therapist | 2519 S Lakeline Blvd, Ste 100, Cedar Park, TX 78613-2964 | 2017-02-08 |
| 1588030209 | Adam Smithers | Physical Therapist | 2519 S Lakeline Blvd, Suite 100, Cedar Park, TX 78613-2964 | 2015-08-17 |
| 1538585476 | Timothy Ho-yen Man | Physical Therapist | 2519 S Lakeline Blvd, Cedar Park, TX 78613-2964 | 2014-03-17 |
| 1477807527 | Amy Elaine Johnson | Occupational Therapist | 2519 S Lakeline Blvd, Cedar Park, TX 78613-2964 | 2012-10-27 |
| 1316297807 | Jeannie E Ritzheimer | Physical Therapist | 2519 S Lakeline Blvd, Suite 100, Cedar Park, TX 78613-2964 | 2012-09-12 |
| 1437404191 | Kelly Ann Duke | Physical Therapist | 2519 S Lakeline Blvd, Suite 100, Cedar Park, TX 78613-2964 | 2012-07-18 |
| 1427303189 | Douglas Farrell Kelley | Physical Therapist | 2519 S Lakeline Blvd, Suite 100, Cedar Park, TX 78613-2964 | 2012-07-18 |
| 1851675581 | Mary Faith Grimberg | Physical Therapist | 2519 S Lakeline Blvd, Suite 100, Cedar Park, TX 78613-2964 | 2011-09-29 |
| 1912298324 | Americus Healthcare, Dme | Durable Medical Equipment & Medical Supplies | 2519 S Lakeline Blvd, Suite 101, Cedar Park, TX 78613-2964 | 2011-04-20 |
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|---|---|---|---|---|
| 1841891280 | Honor Audiology, LLC | Audiologist | 1807 Cypress Creek, Ste 106, Ceder Park, TX 78613 | 2020-11-03 |
| 1750980801 | Sheneil Roberts | Pharmacist | 101 Commercial Pkwy, Cedar Park, TX 78613 | 2020-10-20 |
| 1821606674 | Whitney Olivia White | Dentist | 4807 183a, Ste 100, Cedar Park, TX 78613 | 2020-07-17 |
| 1427681436 | Alex Parnell | Marriage & Family Therapist | 3000 Polar Lane, 602, Cedar Park, TX 78613 | 2020-02-18 |
| 1497216642 | Rolling Hills Healthcare, Inc. | Hospice Care, Community Based | 1101 Arrow Point Dr Ste 301, Cedar Park, TX 78613 | 2019-03-29 |
| 1265907828 | Mary Kathleen Williams | Clinical Nurse Specialist | 1103 Pagedale Drive, Cedar Park, TX 78613 | 2018-10-10 |
| 1982187514 | Elizabeth Harwell | Physical Therapy Assistant | 1500 Cottonwood Creek Trail, Cedar Park, TX 78613 | 2018-09-10 |
| 1346722246 | Riddhi Gohel | Optometrist | 11200 Lakeline Mall Dr Ste H5, Cedar Park, TX 78613 | 2018-09-06 |
| 1528546736 | Lakeline Emergency Center, LLC | Clinic/Center | 1860 S. Lakeline Blvd, Cedar Park, TX 78613 | 2018-07-31 |
| 1710464458 | Kelsey Alyse Hayes | Dietitian, Registered | 1401 Medical Pkwy B, Suite 101, Cedar Park, TX 78613 | 2018-07-25 |
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| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225688567 | Envision Rehab LLC | Clinic/Center | 3621 E Whitestone Blvd Ste 400, Cedar Park, TX 78613-7073 | 2019-09-18 |
| 1487905170 | Whitestone Physical Therapy Lp | Clinic/Center | 715 Discovery Blvd Ste 411, Cedar Park, TX 78613-2417 | 2012-09-21 |
| 1205479516 | Tyler Althof | Clinic/Center | 715 Discovery Blvd Ste 411, Cedar Park, TX 78613-2417 | 2019-10-21 |
| 1396100731 | Agilitas Usa, Inc | Clinic/Center | 1335 E Whitestone Blvd Bldg O100, Cedar Park, TX 78613-0047 | 2015-12-30 |
| 1396043550 | Physiotherapy Associates, Inc. | Clinic/Center | 351 Cypress Creek Rd, Suite 200, Cedar Park, TX 78613-4528 | 2011-03-11 |
| 1134367451 | Milestones Services, Pllc | Clinic/Center | 1460 E Whitestone Blvd, Cedar Park, TX 78613-2210 | 2009-01-23 |
| 1871626077 | Milestones Children's Therapy | Clinic/Center | 1490 E Whitestone Blvd, Ste 100, Cedar Park, TX 78613-2274 | 2007-03-14 |
| 1811946023 | Evolve Physical Therapy and Sports Center Inc | Clinic/Center | 1103 Cypress Creek Rd, Ste 103, Cedar Park, TX 78613-3924 | 2006-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073114609 | Grace Physical Therapy and Wellness | Clinic/Center | 2218 Ridgedale Dr, Arlington, TX 76013-5423 | 2020-11-02 |
| 1992306419 | Victory Wellness Pllc | Clinic/Center | 7209 Fair Valley Way, Plano, TX 75024-3487 | 2020-11-02 |
| 1639770100 | Modern Physical Therapy | Clinic/Center | 5151 Katy Fwy Ste 209, Houston, TX 77007-2260 | 2020-11-02 |
| 1477154011 | Innovative Occupational Therapy | Clinic/Center | 1100 Lake Carolyn Pkwy, Irving, TX 75039-4701 | 2020-11-02 |
| 1760082390 | Optimal Physical Therapy & Pain Relief | Clinic/Center | 3400 Mcmillen Rd Apt 7305, Wylie, TX 75098-7729 | 2020-11-01 |
| 1750981502 | Parikshit Jayant Davda | Clinic/Center | 1620 Magbolia Street, Liberty, TX 77575 | 2020-10-30 |
| 1841898137 | Pineywoods Physical Therapy LLC | Clinic/Center | 1400 West 6th Street, Suite 6 and 7, Rusk, TX 75785 | 2020-10-09 |
| 1457958225 | Majestic Rehabilitation and Wellnes Inc | Clinic/Center | 11199 Pellicano Dr Ste A, El Paso, TX 79935-5304 | 2020-10-05 |
| 1053928093 | Aleya Wellness Pllc | Clinic/Center | 2528 Rusty Spur, Leander, TX 78641-8797 | 2020-09-24 |
| 1679189351 | Omega Sport Physical Therapy and Performance LLC | Clinic/Center | 5432 Holly Rd, Corpus Christi, TX 78411-4635 | 2020-09-18 |
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| City | CEDAR PARK |
| Zip Code | 78613 |
Please comment or provide details below to improve the information on TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC.
| 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.