Individual provider Active NPI

Tyler Worsham, DPT

  • Physical Therapist
  • Melissa, TX
National Provider Identifier
1013606821
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1380753 Issued in TX
Practice address
3059 Champion Way Ste 400
Melissa, TX 75454-2795
Phone
(469) 885-8671
NPI assigned
May 8, 2023
Last updated
Sep 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1380753 TX Primary

Addresses

Primary practice location

3059 Champion Way Ste 400
Melissa, TX 75454-2795

Mailing address

1089 W Exchange Pkwy Apt 5202
Allen, TX 75013-7040
Phone (817) 988-0503

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230828000314 TX Practitioner - Physical Therapist in Private Practice 1254794050 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vista Physical Therapy LLCGroup PAC ID 4284010893, 18 clinicians

Practice addresses (Care Compare)

3059 Champion Way
Suite 400
Melissa, TX 75454-2795
Phone (469) 885-8671

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vista Rehab Partners Physical Therapist CurrentSince Jul 3, 2023 Accepting new patients
Vista Physical Therapy LLC Physical Therapist CurrentSince Feb 1, 2024 Accepting new patients
Vista Rehab Partners, LP Physical Therapist Current Accepting new patients
Vista Rehab Partners LP Physical Therapist CurrentSince Jul 3, 2023 Accepting new patients

Locations

2600 Dallas Pkwy
Ste 290
Frisco, TX 75034
Phone (945) 260-0010

3059 Champion Way
Ste 400
Melissa, TX 75454
Phone (469) 885-8671

821 N Coleman St
Ste 160
Prosper, TX 75078
Phone (972) 347-1111

7720 Highway 78
Sachse, TX 75048
Phone (972) 761-5501

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1013606821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1089 W EXCHANGE PKWY APT 5202",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750137040",
            "telephone_number": "817-988-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3059 CHAMPION WAY STE 400",
            "city": "MELISSA",
            "state": "TX",
            "postal_code": "754542795",
            "telephone_number": "469-885-8671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORSHAM",
        "first_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-08",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1380753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melissa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.