Kelly Jane Tangen, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT21694 Issued in FL

Practice address

3903 Northdale Blvd
Ste 111W
Tampa, FL 33624-1864

Phone

(813) 418-7350

Fax

(813) 265-2504

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Theriault Former name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimal Performance and Physical Therapies St. Joes LLCGroup PAC ID 3971798687, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Optimal Performance and Physical Therapies St. Joes LLC

  • Physical Therapist
  • Tampa, FL
  • NPI 1174831523

  FL

  Medicare reassignment Care Compare group
• Optimal Performance and Physical Therapies Hyde Park LLC

  • Physical Therapist
  • Tampa, FL
  • NPI 1528381621

  FL, Physical Therapist

  Medicare reassignment NPD
• Optimal Performance and Physical Therapies Northdale LLC

  • Physical Therapist
  • Tampa, FL
  • NPI 1740511195

  FL, Physical Therapist

  Medicare reassignment NPD
• Optimal Performance and Physical Therapies Northdale LLC

  • Physical Therapy Clinic/Center
  • Tampa, FL
  • NPI 1093399347

  Physical Therapist

  NPD
• Physiotherapy Associates Inc

  • Physical Therapy Clinic/Center
  • Estero, FL
  • NPI 1720039902
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401667200000",
    "number": "1083710461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 NORTHDALE BLVD",
            "address_2": "STE 111W",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241864",
            "telephone_number": "813-418-7350",
            "fax_number": "813-265-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 NORTHDALE BLVD",
            "address_2": "STE 111W",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336241864",
            "telephone_number": "813-418-7350",
            "fax_number": "813-265-2504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANGEN",
        "first_name": "KELLY",
        "middle_name": "JANE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2014-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT21694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "THERIAULT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Thoai Nhan Pham Tang
• Xinmin Tang, M.D.
• Ziwei Tang
• Deborah Tanga, APRN
• Robert Tangariffe, BCBA
• Michael Christopher Tangen, P.T.
• Tania Health Inc
• Tania Paquin Lozano MD PA
• Justin Christopher Tank
• Luciana Tann, P.A.

• Physical Therapist in Tampa, FL
• Providers in Tampa, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; 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.