NPIMap

Organization Active NPI

First Colony Rehab, LLC

Doing business as Tideway Physical Therapy

  • Physical Therapy Clinic/Center
  • Galveston, TX
National Provider Identifier
1720028459
Registry record updated Sep 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FIRST COLONY REHAB, LLC
Doing business as
Tideway Physical Therapy
Practice address
6444 Central City Blvd
Galveston, TX 77551-2058
Phone
(409) 741-8472
Fax
(409) 741-2342
NPI assigned
Jun 8, 2006
Last updated
Sep 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2021

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

Authorized official

Name
Kendall Gill, PTNPI 1073963641
Title
Owner
Phone
(817) 929-1420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

6444 Central City Blvd
Galveston, TX 77551-2058

Mailing address

PO Box 3106
Galveston, TX 77552-0106
Phone (409) 741-8472

Other names 1

  • Tideway Physical Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL kgill@tidewaytherapy.com First Colony Rehab, LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090714000715 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9234190224 Receives reassigned benefits from 2 practitioners
Practice locations: Galveston, TX

National Provider Directory

National Provider Directory

Locations

1021 61st St
Ste B100B
Galveston, TX 77551
Phone (409) 741-8472

6444 Central City Blvd
#H2O
Galveston, TX 77551
Phone (409) 741-8472

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631232000000",
    "number": "1720028459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3106",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775520106",
            "telephone_number": "409-741-8472",
            "fax_number": "409-741-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6444 CENTRAL CITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775512058",
            "telephone_number": "409-741-8472",
            "fax_number": "409-741-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COLONY REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-09-10",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-929-1420",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kgill@tidewaytherapy.com",
            "affiliation": "Y",
            "endpointDescription": "HIH email",
            "affiliationName": "First Colony Rehab, LLC",
            "address_1": "6444 Central City Blvd",
            "city": "Galveston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "775512058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Tideway Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galveston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.