Active NPI
Jonathan Carlson, PT, DPT
- Physical Therapist
- Tyler, TX
National Provider Identifier
1245022516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1406779
- Practice address
- 4025 S Broadway Ave
Tyler, TX 75701-8727 - Phone
- (903) 561-2690
- NPI assigned
- May 21, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1406779 | TX | Primary |
Addresses
Primary practice location
4025 S Broadway Ave
Tyler, TX 75701-8727
Mailing address
7790 County Road 2193 Apt 39
Whitehouse, TX 75791-9442
Phone (720) 402-1930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1406779 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747785600000",
"number": "1245022516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7790 COUNTY ROAD 2193 APT 39",
"city": "WHITEHOUSE",
"state": "TX",
"postal_code": "757919442",
"telephone_number": "720-402-1930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4025 S BROADWAY AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757018727",
"telephone_number": "903-561-2690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "JONATHAN",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-21",
"last_updated": "2025-05-21",
"certification_date": "2025-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1406779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.