Malia Tidwell

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA209020 Issued in FL

Practice address

112 W Citrus St
Altamonte Springs, FL 32714-2502

Phone

(407) 865-5642

NPI assigned

Jan 15, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Can DO Therapies, Inc.

  • Clinic/Center
  • Altamonte Springs, FL
  • NPI 1396938056
  NPD (past)

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

{
    "created_epoch": "1547510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1639643463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 E PINEWOOD CT",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327465900",
            "telephone_number": "407-923-4090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W CITRUS ST",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327142502",
            "telephone_number": "407-865-5642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "MALIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-15",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA209020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL LICENSE NUMBER",
            "identifier": "PTA209020",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Thompson
• Shayna Thompson, LMT
• Tonya Thompson, CSFA
• Thrive Assisted Home Care LLC
• Shelbi Thurston
• Ryan Scott Tidwell, APRN
• Time to Heal Counseling, LLC
• Prisa Titiwaratohn
• Merida Toala, LE
• Todd C. Hartley, M.D., P.a.

• Physical Therapy Assistant in Altamonte Springs, FL
• Providers in Altamonte Springs, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; 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.