Christopher M Thibodeaux, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2163589 Issued in TX

Practice address

527 Tuskegee Airmen Ave
BLDG 500
Sheppard AFB, TX 76311

Phone

(940) 676-4274

NPI assigned

Jul 7, 2022

Last updated

Aug 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1629701594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4107 ABBOTT AVE",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763083401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 TUSKEGEE AIRMEN AVE",
            "address_2": "BLDG 500",
            "city": "SHEPPARD AFB",
            "state": "TX",
            "postal_code": "76311",
            "telephone_number": "940-676-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAUX",
        "first_name": "CHRISTOPHER",
        "middle_name": "M",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-07",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2163589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Martin Trevino, LCSW, LCDC

• Physical Therapy Assistant in Sheppard AFB, TX
• Providers in Sheppard AFB, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.