Cooper Vaughn Tietz, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13278 Issued in MN

Practice address

1245 Washington Ave
Detroit Lakes, MN 56501-3905

Phone

(218) 846-2000

NPI assigned

Aug 29, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford Medical Center FargoGroup PAC ID 8426967803, shared by 30 NPIs, 1,210 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sanford Medical Center Fargo

  • Ambulatory Surgical Clinic/Center
  • Detroit Lakes, MN
  • NPI 1922303213
  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  MN

  Medicare reassignment NPD
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  NPD
• Sanford Medical Center Fargo

  • Home Health Agency
  • Fargo, ND
  • NPI 1891861761
  NPD (past)

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1821873795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013905",
            "telephone_number": "218-846-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9285 Medical Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294069126",
            "country_code": "US",
            "telephone_number": "843-797-8282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIETZ",
        "first_name": "COOPER",
        "middle_name": "VAUGHN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-29",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "13278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lacey R Thiel, OTR/L
• James Arthur Thom, LAC
• Tessa L Thomas, MPT
• Hallie Thompson, MD
• Taylor Jones Thooft, PHARMD
• Kansas Tilbury
• Kelsey Tjepkes
• Carrie A Tobkin, PT
• James J Torkildson, ED.D.
• Thomas N. Truedson, LAT, ATC

• Physical Therapist in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.