NPIMap

Organization Active NPI

Tillman Physical Therapy & Sports Training Center, Inc

  • Physical Therapy Clinic/Center
  • Cedar Park, TX
National Provider Identifier
1376579797
Registry record updated Mar 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
644350000 Issued in TX
Legal business name
TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC
Practice address
2519 S Lakeline Blvd
Suite 100
Cedar Park, TX 78613-2964
Phone
(512) 331-6200
Fax
(512) 331-4312
NPI assigned
Jun 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2011

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

Authorized official

Name
Michael Ray Tillman, MPT, CSCS, CERT. MDTNPI 1376571919
Title
Phyical Therapist President
Phone
(512) 331-6200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 554280000 TX
Physical Therapy Clinic/Center 261QP2000X 644350000 TX Primary

Addresses

Primary practice location

2519 S Lakeline Blvd
Suite 100
Cedar Park, TX 78613-2964

Mailing address

2519 S Lakeline Blvd
Suite 100
Cedar Park, TX 78613-2964
Phone (512) 331-6200

Other identifiers 1

IdentifierTypeStateIssuer
153870401MedicaidTX

Other names 1

  • Tillman Physical Therapy & Sports Training Center, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080618000271 TX Part B Supplier - Clinic/Group Practice 9638240773 Receives reassigned benefits from 12 practitioners
Practice locations: Cedar Park, TX

National Provider Directory

National Provider Directory
Tax ID family
Tillman PT Sports Training2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11007 Ranch Road 2222
Austin, TX 78730
Phone (512) 792-4041

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1376579797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 S LAKELINE BLVD",
            "address_2": "SUITE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132964",
            "telephone_number": "512-331-6200",
            "fax_number": "512-331-6384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2519 S LAKELINE BLVD",
            "address_2": "SUITE 100",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786132964",
            "telephone_number": "512-331-6200",
            "fax_number": "512-331-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PHYICAL THERAPIST   PRESIDENT",
        "authorized_official_telephone_number": "512-331-6200",
        "authorized_official_credential": "MPT, CSCS, CERT. MDT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "554280000",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TX",
            "license": "644350000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "153870401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tillman Physical Therapy & Sports Training Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cedar Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.