Ryan Tisdall, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501016891 Issued in MI

Practice address

40440 Grand River Ave Ste D
Novi, MI 48375-2873

Phone

(248) 957-9430

Fax

(248) 436-4929

NPI assigned

Sep 8, 2014

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

• Kinesis Physical Therapy and Performance

  • Physical Therapy Clinic/Center
  • Novi, MI
  • NPI 1114513033
  NPD Authorized official

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1871994046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40440 GRAND RIVER AVE STE D",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752873",
            "telephone_number": "248-957-9430",
            "fax_number": "248-436-4929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40440 GRAND RIVER AVE STE D",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483752873",
            "telephone_number": "248-957-9430",
            "fax_number": "248-436-4929"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "799 Denison Ct",
            "address_purpose": "LOCATION",
            "city": "Bloomfield Hills",
            "state": "MI",
            "postal_code": "483020053",
            "country_code": "US",
            "telephone_number": "248-322-5280",
            "fax_number": "248-333-1915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALL",
        "first_name": "RYAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-08",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501016891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawntenique Tillis
• Timothy R Kirk OD PC
• Elizabeth Wilson Tindal, MD MPH
• Connie Tindall, MT
• Aaron Tisack
• Shannon Titus
• Tlec Corp
• Juan Tobar
• Christina Todd
• Jenna Todd

• Physical Therapist in Novi, MI
• Providers in Novi, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.