Tyler Gdovin

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01950800 Issued in NJ

Practice address

508 10TH Ave
Belmar, NJ 07719-2317

Phone

(732) 910-9196

NPI assigned

Oct 23, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healing Star Physical Therapy and Wellness LLCGroup PAC ID 4688824816, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Healing Star Physical Therapy and Wellness LLC

  • Specialist
  • Eatontown, NJ
  • NPI 1598011207

  NJ, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Coastal Home Rehabilitation, LLC

  • Multi-Specialty Clinic/Center
  • Belmar, NJ
  • NPI 1316236664

  NJ, Physical Therapist

  Medicare reassignment NPD
• Pearl Rehabilitation LLC

  • Physical Medicine & Rehabilitation Physician
  • Shrewsbury, NJ
  • NPI 1225630122

  NJ

  Medicare reassignment NPD
• Parker Creek Neurorehabilitation

  • Physical Therapy Clinic/Center
  • Little Silver, NJ
  • NPI 1740743467
  NPD (past)

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1043819634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 10TH AVE",
            "city": "BELMAR",
            "state": "NJ",
            "postal_code": "077192317",
            "telephone_number": "732-910-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 10TH AVE",
            "city": "BELMAR",
            "state": "NJ",
            "postal_code": "077192317",
            "telephone_number": "732-910-9196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GDOVIN",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01950800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Rose Faller, PT, DPT
• Kerry Flanagan
• Steven T Fortunato, BCBA
• Lauren Gargiulo, OTR/L
• Jessica Garretson
• Joan Gilliland
• Tara Golding
• Allison Rose Gorczyca
• Christopher M Grande, ATC
• Kimberly Grande, DPT, ATC

• All providers in Belmar, NJ
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; 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.