Individual provider Active NPI

Todd R Tiepelman, P.T.A

  • Physical Therapy Assistant
  • Saint Louis, MO
National Provider Identifier
1386838613
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
116851 Issued in MO
Practice address
845 N New Ballas CT
Suite 40
Saint Louis, MO 63141-7134
Phone
(314) 872-1644
Fax
(314) 872-1801
NPI assigned
Aug 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 116851 MO Primary

Addresses

Primary practice location

845 N New Ballas CT
Suite 40
Saint Louis, MO 63141-7134

Mailing address

4850 Lemay Ferry Rd
Suite 101
Saint Louis, MO 63129-1576
Phone (314) 416-0439

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

LicenseStateTypeSpecialty
116851MOMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Healthcare Foundation 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.

NPI Registry JSON

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188345600000",
    "number": "1386838613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 LEMAY FERRY RD",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631291576",
            "telephone_number": "314-416-0439",
            "fax_number": "314-487-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT",
            "address_2": "SUITE 40",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417134",
            "telephone_number": "314-872-1644",
            "fax_number": "314-872-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIEPELMAN",
        "first_name": "TODD",
        "middle_name": "R",
        "credential": "P.T.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-29",
        "last_updated": "2007-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "116851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.