Active NPI
Mark David Picou, PT
- Physical Therapist
- Nacogdoches, TX
National Provider Identifier
1255385209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1071991
- Practice address
- 3909 NE Stallings Dr
Nacogdoches, TX 75965 - Phone
- (936) 564-7780
- Fax
- (936) 564-0745
- NPI assigned
- May 22, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 1071991 | TX | Primary |
Addresses
Primary practice location
3909 NE Stallings Dr
Nacogdoches, TX 75965
Mailing address
3909 NE Stallings Dr
Nacogdoches, TX 75965-2169
Phone (936) 564-7780
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1071991 | Other | TX | TX BOARD OF PT EXAMINERS |
| 021252401 | Medicaid | TX |
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 |
|---|---|---|---|
| 1071991 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nacogdoches Physical Therapy LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Nacogdoches, TX
- NPI 1316991441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309132800000",
"number": "1255385209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3909 NE STALLINGS DR",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759652169",
"telephone_number": "936-564-7780",
"fax_number": "936-564-0745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3909 NE STALLINGS DR",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "75965",
"telephone_number": "936-564-7780",
"fax_number": "936-564-0745"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICOU",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2011-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1071991",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TX BOARD OF PT EXAMINERS",
"identifier": "1071991",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "021252401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.