Tirzah Grace Antoine, PT
Individual provider Active NPI Physical Therapist · Wallingford, CT
NPI 1508299496 · NPPES record last updated Apr 6, 2016
Key facts
- NPI
- 1508299496
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 10703 (CT)
- Practice address
- 85 Barnes Rd
Suite 109
Wallingford, CT 06492-1832 - Phone
- (203) 697-1067
- Fax
- (203) 284-0492
- NPI assigned
- Aug 14, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DC Luna Care Physical Therapy LLC
Practice addresses (Care Compare)
1717 K St NW
Suite 900
Washington, DC 20006-5349
Phone (916) 232-3047
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200817002731 | DC | Practitioner - Physical Therapist in Private Practice | 5991094641 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27451 | MD | MD | Pharmacist |
| 036636 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DC Luna Care Physical Therapy LLC | Physical Therapist | Current |
Accepting new patients |
| Physiotherapy Associates Inc | Current |
Accepting new patients | |
| Physiotherapy Associates Inc | Physical Therapist | Current |
Accepting new patients |
Locations
1717 K St NW
Ste 900
Washington, DC 20006
Phone (916) 232-3047
600 Pennsylvania Ave SE
Ste 202
Washington, DC 20003
Phone (202) 543-9400
6308 Democracy Blvd
Bethesda, MD 20817
Phone (301) 530-2383
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 036636 | NY | |
| Physical Therapist | 225100000X | 10703 | CT | Yes |
Addresses
Primary practice location
85 Barnes Rd
Suite 109
Wallingford, CT 06492-1832
Mailing address
85 Barnes Rd
Suite 109
Wallingford, CT 06492-1832
Phone (203) 697-1067
Other names
- Tirzah Grace Davis
Other providers in Wallingford, CT
- Richard Harold Anderson
- Ryan William Andrews
- Jacqueline E Anglin-Dixon
- Gabrielle Annino
- Anthem Health Plans, Inc.
- Senen Joaquin Antunez-Tierney
- Bristyn Aquilino
- Jamie Arber
- Arc in Home Addiction Treatment, P.C.
- Arc Light Behavioral Health Collective LLC
All providers in Wallingford, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.