Individual provider Active NPI

Marc Conrad Ty Tentativa, PT

  • Physical Therapist
  • McKinney, TX
National Provider Identifier
1407488562
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1328172 Issued in TX
Practice address
3951 Alma Rd Ste 201
McKinney, TX 75070
Phone
(469) 456-4155
NPI assigned
Feb 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1328172 TX Primary
Physical Therapist 225100000X 1328172

Addresses

Primary practice location

3951 Alma Rd Ste 201
McKinney, TX 75070

Mailing address

15410 S Mountain Pkwy Ste 112
Phoenix, AZ 85044-6691
Phone (480) 689-5534

Other practice location 1

2600 Eldorado Pkwy Ste 130
McKinney, TX 75070-7517
Phone (972) 984-7670

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210121001473 TX Practitioner - Physical Therapist in Private Practice 7113331893 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elata Health and Wellness, LLCGroup PAC ID 8527359652, 6 clinicians

Practice addresses (Care Compare)

2600 Eldorado Pkwy
130 Active Life Physical Therapy
McKinney, TX 75070-7517
Phone (972) 984-7670

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1328172TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tenacity Performance Health and Wellness LLC Physical Therapist CurrentSince Aug 4, 2025 Accepting new patients
M a P Active - McKinney LLC Physical Therapist CurrentSince Feb 1, 2020 Accepting new patients

Locations

2600 Eldorado Pkwy
Ste 130
McKinney, TX 75070
Phone (972) 984-7670

3951 Alma Rd
Ste 201
McKinney, TX 75070
Phone (214) 548-4155

Organizations & group practices 3

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": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1407488562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15410 S MOUNTAIN PKWY STE 112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850446691",
            "telephone_number": "480-689-5534",
            "fax_number": "480-706-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3951 ALMA RD STE 201",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "75070",
            "telephone_number": "469-456-4155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Eldorado Pkwy Ste 130",
            "address_purpose": "LOCATION",
            "city": "McKinney",
            "state": "TX",
            "postal_code": "750707517",
            "country_code": "US",
            "telephone_number": "972-984-7670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TENTATIVA",
        "first_name": "MARC CONRAD",
        "middle_name": "TY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-06",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1328172",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": "1328172",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinney, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; 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.