Timothy M Theriault, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1069417 Issued in TX

Practice address

17051 Dallas Pkwy Ste 430
Addison, TX 75001-7111

Phone

(469) 248-3962

Fax

(469) 206-0697

NPI assigned

Jun 13, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Luna Care Physical Therapy LLCGroup PAC ID 0648692723, 271 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.

• Texas Luna Care Physical Therapy LLC

  • Physical Therapist
  • Southlake, TX
  • NPI 1790309656
  Medicare reassignment Care Compare group NPD
• Vista JV Partners LLC

  • Multi-Specialty Clinic/Center
  • Lake Worth, TX
  • NPI 1326753377

  Physical Therapist

  Medicare reassignment NPD
• Metdalspi, LLC

  • General Acute Care Hospital
  • Addison, TX
  • NPI 1023338142
  NPD (past)
• Michael Daley

  • Physical Therapist
  • Southington, CT
  • NPI 1417995549
  NPD (past)
• Orthopedic Physical Therapy LLC

  • Physical Therapist
  • Southington, CT
  • NPI 1699950014
  NPD (past)

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652486400000",
    "number": "1336343490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 STANLEY FALLS DR",
            "city": "ANNA",
            "state": "TX",
            "postal_code": "754095049",
            "telephone_number": "469-487-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 DALLAS PKWY STE 430",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017111",
            "telephone_number": "469-248-3962",
            "fax_number": "469-206-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIAULT",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2022-05-14",
        "certification_date": "2022-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1069417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vaishali Thati, M.D.
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• The Medical Center Pharmacy LTD Co
• Therapy Centers of South Carolina, P.a.
• Therapy Centers of the Southwest I, P.a., P.C. (Or)
• Stacey Merin Thomas
• Stephanie Thomas, MS, CCC-SLP
• Titan Interventional Pain Center LLC
• Dana Breann Tolleson
• Quynh A Ton-That, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2022; 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.