Samuel Tidalgo

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

046852 Issued in NY

Practice address

139 Fulton St RM 502
New York, NY 10038-2535

Phone

(315) 879-9481

NPI assigned

Aug 21, 2024

Last updated

Sep 29, 2026By the provider in NPPES

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

Enrolled in NY, NJ2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sportsmed PT LLCGroup PAC ID 0749535805, 183 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sportsmed PT LLC

  • Physical Therapist
  • Glen Rock, NJ
  • NPI 1841787645
  Medicare reassignment Care Compare group NPD
• Elite Physical Therapy and Rehabilitation LLC

  • Physical Therapist
  • Purchase, NY
  • NPI 1508986464
  Medicare reassignment NPD

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

{
    "created_epoch": "1724198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1922831353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 FULTON ST RM 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100382535",
            "telephone_number": "315-879-9481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 FULTON ST RM 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100382535",
            "telephone_number": "315-879-9481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDALGO",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-21",
        "last_updated": "2026-09-29",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Nomi Tichenor
• Wellington Shelton Tichenor, M.D.
• Carol Tichler, CSW
• Aleksandr Manfred Tichter, M.D.
• Satish K Tickoo, MD
• Kelsey Tidland
• Alexa Tidwell, FNP-BC
• Amber Nickolina Tidwell, NP
• Patricia Ruth Tidwell, LCSW
• Edward Tie, MD

• Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.