Individual provider Active NPI

Allen Tyler Nance, P.T.

  • Physical Therapist
  • Gautier, MS
National Provider Identifier
1124023197
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
00004730 Issued in TN
Practice address
6510 Highway 90 Ste D
Gautier, MS 39553-5015
Phone
(228) 875-7259
Fax
(228) 438-2038
NPI assigned
Jun 16, 2005
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 00004730 TN
Physical Therapist 225100000X 00004730 TN Primary

Addresses

Primary practice location

6510 Highway 90 Ste D
Gautier, MS 39553-5015

Mailing address

PO Box 200880
Dallas, TX 75320-0880
Phone (678) 837-7176

Other identifiers 1

IdentifierTypeStateIssuer
3652689MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA, MS3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20130624000569 TN Practitioner - Physical Therapist in Private Practice 4789876434 Reassigns benefits to 2 organizations
I20230516000489 VA Practitioner - Physical Therapist in Private Practice 4789876434 Reassigns benefits to 1 organization
I20241119000600 MS Practitioner - Physical Therapist in Private Practice 4789876434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6510 Hwy 90
Suite D
Gautier, MS 39553-5015
Phone (228) 438-2038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
00004730TNMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
PT Solutions LLC Physical Therapist CurrentSince Apr 4, 2016 Accepting new patients
Physical Therapy Center of Ocean Springs, LLC Physical Therapist CurrentSince Sep 16, 2024 Accepting new patients
PT Solutions, LLC CurrentSince Apr 4, 2016 Accepting new patients
PT Solutions, LLC Physical Therapist CurrentSince Apr 1, 2023 Accepting new patients
PT Solutions LLC Physical Therapist CurrentSince Apr 4, 2016 Accepting new patients
Takoma Regional Hospital, Inc Past Accepting new patients
PT Solutions LLC Physical Therapist PastSince Feb 16, 2020 Accepting new patients

Locations

1100 Circle 75 Pkwy SE
Ste 1400
Atlanta, GA 30339
Phone (678) 403-3555

6510 Highway 90
#D
Gautier, MS 39553
Phone (228) 438-2038

900 Holcomb Blvd
#A
Ocean Springs, MS 39564
Phone (228) 872-6821

1321 Tusculum Blvd
Unit 9
Greeneville, TN 37745
Phone (423) 798-8420

3135 Peoples St
Johnson City, TN 37604
Phone (423) 454-1006

444 Clinchfield St
Ste 102
Kingsport, TN 37660
Phone (423) 212-5966

11135 Kingston Pike
Knoxville, TN 37934
Phone (865) 381-5658

54 Floyd Pike
Hillsville, VA 24343
Phone (276) 728-7280

1050 Holston Rd
Wytheville, VA 24382
Phone (276) 238-8900

Organizations & group practices 7

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1124023197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200880",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753200880",
            "telephone_number": "678-837-7176",
            "fax_number": "404-777-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6510 HIGHWAY 90 STE D",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535015",
            "telephone_number": "228-875-7259",
            "fax_number": "228-438-2038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NANCE",
        "first_name": "ALLEN",
        "middle_name": "TYLER",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TN",
            "license": "00004730",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "00004730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3652689",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gautier, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; 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.