Individual provider Active NPI

Jared Bret Timothy Daigle, DPT

  • Physical Therapist
  • Pearland, TX
National Provider Identifier
1720697816
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1390568 Issued in TX
Practice address
2637 Lazy Bend St Ste 101
Pearland, TX 77581-1007
Phone
(281) 485-4144
NPI assigned
Jul 24, 2020
Last updated
Apr 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10503 LA
Physical Therapist 225100000X 1390568 TX Primary
Physical Therapist 225100000X PTL.0018179 CO
Physical Therapist 225100000X LPT-33106 AZ

Addresses

Primary practice location

2637 Lazy Bend St Ste 101
Pearland, TX 77581-1007

Mailing address

2637 Lazy Bend St Ste 101
Pearland, TX 77581-1007
Phone (281) 485-4144

Other identifiers 1

IdentifierTypeStateIssuer
1174173MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201119000032 LA Practitioner - Physical Therapist in Private Practice 2769893957

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPT-33106AZMDPhysical Therapist
PTL.0018179COMDPhysical Therapist
10503LAMDPhysical Therapist
1390568TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Uchealth Community Services Physical Therapist CurrentSince Jan 18, 2022 Accepting new patients
Poudre Valley Medical Group, LLC Past Accepting new patients
Ideal Rehabilitation LLC PastSince May 22, 2023 Accepting new patients

Locations

175 Inverness Dr W
Ste 100
Greenwood Village, CO 80112
Phone (303) 964-3333

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": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1720697816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2637 LAZY BEND ST STE 101",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775811007",
            "telephone_number": "281-485-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 LAZY BEND ST STE 101",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775811007",
            "telephone_number": "281-485-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAIGLE",
        "first_name": "JARED",
        "middle_name": "BRET TIMOTHY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-24",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "10503",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1390568",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0018179",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-33106",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174173",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.