Marc Gelinas

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1082683 Issued in TX

Practice address

1710 Egret LN
Southlake, TX 76092-5800

Phone

(817) 821-5494

NPI assigned

Apr 30, 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

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1285255372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 EGRET LN",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925800",
            "telephone_number": "817-821-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 EGRET LN",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925800",
            "telephone_number": "817-821-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GELINAS",
        "first_name": "MARC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-30",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1082683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS PHYSICAL THERAPY LICENSE NUMBER",
            "identifier": "1082683",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA PHYSICAL THERAPY LICENSE",
            "identifier": "P627",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Computer",
            "affiliation": "N",
            "endpointDescription": "Secure Computer Device",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Text",
            "address_1": "1710 Egret Ln",
            "city": "Southlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760925800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Southlake, TX
• Providers in Southlake, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.