Individual provider Active NPI

Tiffany Monet Fondren, PT, DPT

  • Physical Therapist
  • Cartersville, GA
National Provider Identifier
1609357177
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT013610 Issued in GA
Practice address
150 Gentilly Blvd
Cartersville, GA 30120-8522
Phone
(678) 719-7000
NPI assigned
Aug 23, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT013610 GA Primary

Addresses

Primary practice location

150 Gentilly Blvd
Cartersville, GA 30120-8522

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other names 1

  • Dr. Tiffany Monet Lambert-Lucas Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190213002190 SC Practitioner - Physical Therapist in Private Practice 5395080287 Reassigns benefits to 1 organization
I20221102000140 TX Practitioner - Physical Therapist in Private Practice 5395080287 Reassigns benefits to 1 organization

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
Ideal Physical Therapy of Texas LLCGroup PAC ID 0547583809, 359 clinicians

Practice addresses (Care Compare)

1180 E Prosper TRL
Suite 50
Prosper, TX 75078-5511
Phone (469) 481-3031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9261SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Oct 4, 2022 Accepting new patients
Greenville Proaxis Therapy LLC CurrentSince Jan 1, 2019 Accepting new patients
Ideal Physical Therapy of Texas LLC CurrentSince Oct 4, 2022 Accepting new patients
Greenville Proaxis Therapy, LLC Physical Therapist CurrentSince Jan 1, 2019 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33205 Collection Ctr Dr
Chicago, IL 60693

103 N Main St
Ste 201
Greenville, SC 29601
Phone (864) 528-5753

1305 S Suber Rd
Greer, SC 29650
Phone (864) 989-4609

315 Medical Pkwy
Ste 150
Greer, SC 29650
Phone (864) 695-1418

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

1555 US Highway 380
Ste 900
Frisco, TX 75033
Phone (972) 346-5634

8845 Gary Burns Dr
Ste 100
Frisco, TX 75034
Phone (469) 403-2090

6828 Stonebrook Pkwy
Ste 300
Frisco, TX 75034
Phone (469) 403-2022

2180 FM 423
Ste 300
Little Elm, TX 75068
Phone (469) 403-2242

3241 S Custer Rd
Ste 101
McKinney, TX 75070

3520 W University Dr
Ste 201
McKinney, TX 75071
Phone (469) 307-5674

1180 E Prosper Trl
Ste 50
Prosper, TX 75078
Phone (469) 481-3031

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

Organizations & group practices 4

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": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1609357177",
    "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": "150 GENTILLY BLVD",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301208522",
            "telephone_number": "678-719-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONDREN",
        "first_name": "TIFFANY",
        "middle_name": "MONET",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-23",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "LAMBERT-LUCAS",
            "middle_name": "MONET",
            "prefix": "DR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cartersville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; 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.