Individual provider Active NPI

Preethi Suresh, PT

  • Physical Therapist
  • Katy, TX
National Provider Identifier
1023770831
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1354060 Issued in TX
Practice address
1115 Avenue D
Katy, TX 77493-2465
Phone
(281) 712-4835
Fax
(832) 437-5709
NPI assigned
Oct 8, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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 1354060 TX Primary

Addresses

Primary practice location

1115 Avenue D
Katy, TX 77493-2465

Mailing address

1115 Avenue D
Katy, TX 77493-2465
Phone (281) 712-4835

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211101002069 TX Practitioner - Physical Therapist in Private Practice 1254729825 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1115 Ave D
Katy, TX 77493-2465
Phone (281) 712-4835

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1354060TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Lagune Therapy, Inc Physical Therapist CurrentSince Jan 1, 2022 Accepting new patients
DMXQ, LLC Physical Therapist CurrentSince Oct 25, 2021 Accepting new patients

Locations

1115 Avenue D
Katy, TX 77493
Phone (281) 712-4835

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633651200000",
    "number": "1023770831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 AVENUE D",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774932465",
            "telephone_number": "281-712-4835",
            "fax_number": "832-437-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 AVENUE D",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774932465",
            "telephone_number": "281-712-4835",
            "fax_number": "832-437-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURESH",
        "first_name": "PREETHI",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1354060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Katy, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.