Active NPI
Paul Marvin Theile, CTRS
- Recreation Therapist
- Gainesville, FL
National Provider Identifier
1821678582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 80710
- Practice address
- 1601 SW Archer Rd
Gainesville, FL 32608-1135 - Phone
- (352) 376-1611
- NPI assigned
- Apr 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 80710 | MS | Primary |
Addresses
Primary practice location
1601 SW Archer Rd
Gainesville, FL 32608-1135
Mailing address
122 SE 70TH Cir
Ocala, FL 34472-7962
Phone (352) 615-0936
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80710 | Other | MS | NCTRC CTRS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | paul.theile@va.gov | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80710 | MS | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617840000000",
"number": "1821678582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 SE 70TH CIR",
"city": "OCALA",
"state": "FL",
"postal_code": "344727962",
"telephone_number": "352-615-0936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326081135",
"telephone_number": "352-376-1611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEILE",
"first_name": "PAUL",
"middle_name": "MARVIN",
"credential": "CTRS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-08",
"last_updated": "2021-04-08",
"certification_date": "2021-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MS",
"license": "80710",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCTRC CTRS",
"identifier": "80710",
"state": "MS"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "paul.theile@va.gov",
"affiliation": "N",
"endpointDescription": "email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1601 SW Archer Rd",
"city": "Gainesville",
"state": "FL",
"country_code": "US",
"postal_code": "326081135",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.