NPIMap

Organization Active NPI

Ideal Physical Therapy of Texas LLC

  • Durable Medical Equipment & Medical Supplies
  • Sunset Valley, TX
National Provider Identifier
1508555897
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
IDEAL PHYSICAL THERAPY OF TEXAS LLC
Practice address
5400 Brodie LN Ste 295
Sunset Valley, TX 78745-2525
Phone
(512) 676-3949
NPI assigned
May 3, 2023
Last updated
Apr 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
Wade A Meyer
Title
VP Chief Compliance Officer
Phone
(630) 296-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

5400 Brodie LN Ste 295
Sunset Valley, TX 78745-2525

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230623002180 TX DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 0547583809 Practice locations: Sunset Valley, TX

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5400 Brodie Ln
Ste 295
Sunset Valley, TX 78745
Phone (512) 676-3949

NPI Registry JSON

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

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1508555897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 BRODIE LN STE 295",
            "city": "SUNSET VALLEY",
            "state": "TX",
            "postal_code": "787452525",
            "telephone_number": "512-676-3949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL PHYSICAL THERAPY OF TEXAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-03",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "630-296-2222"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunset Valley, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; 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.