Individual provider Active NPI

Mariah Hardeman, PT, DPT

  • Physical Therapist
  • Georgetown, TX
National Provider Identifier
1669142295
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1353596 Issued in TX
Practice address
139 Estrella Xing
Georgetown, TX 78628-7055
Phone
(512) 863-2528
NPI assigned
Sep 15, 2021
Last updated
Sep 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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 1353596 TX Primary

Addresses

Primary practice location

139 Estrella Xing
Georgetown, TX 78628-7055

Mailing address

1305 Sheltie LN
Round Rock, TX 78664-3409
Phone (682) 465-0414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211101001464 TX Practitioner - Physical Therapist in Private Practice 1557759115 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Functional Pathways Preferred of Tennessee LLC Physical Therapist CurrentSince Jan 14, 2022 Accepting new patients
Optimal Performance Physical Therapy, PLLC Physical Therapist CurrentSince Apr 16, 2024 Accepting new patients
Sarol Ventures LLC Physical Therapist CurrentSince Jul 5, 2022 Accepting new patients

Locations

10133 Sherrill Blvd
Ste 200
Knoxville, TN 37932
Phone (865) 392-2847

2901 Ranch Road 620 N
Austin, TX 78734
Phone (512) 815-3748

4011 Williams Dr
Georgetown, TX 78628
Phone (512) 868-2700

1700 E Palm Valley Blvd
Ste 395
Round Rock, TX 78664
Phone (512) 354-4067

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1669142295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 SHELTIE LN",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786643409",
            "telephone_number": "682-465-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 ESTRELLA XING",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786287055",
            "telephone_number": "512-863-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDEMAN",
        "first_name": "MARIAH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1353596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; 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.