Individual provider Active NPI

Annette Lettiere, PT

  • Physical Therapist
  • Southlake, TX
National Provider Identifier
1942335948
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1162725 Issued in TX
Practice address
1545 E Southlake Blvd
Suite 100
Southlake, TX 76092-6422
Phone
(817) 442-9300
Fax
(817) 796-0757
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1162725 TX Primary

Addresses

Primary practice location

1545 E Southlake Blvd
Suite 100
Southlake, TX 76092-6422

Mailing address

1545 E Southlake Blvd
Suite 100
Southlake, TX 76092-6422
Phone (817) 442-9300

Other identifiers 1

IdentifierTypeStateIssuer
1162725OtherTXPHYSICAL THERAPIST LICENS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stt@116.direct.myezyaccess.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000560 TX Practitioner - Physical Therapist in Private Practice 7719920503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Back CareGroup PAC ID 1951604313, 50 clinicians

Practice addresses (Care Compare)

3142 Horizon Rd
Suite 100
Rockwall, TX 75032-7815
Phone (817) 442-9300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1162725TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Back Care Physical Therapist CurrentSince Jan 1, 2016 Accepting new patients
Texas Health Back Care Physical Therapist CurrentSince Jan 1, 2016 Accepting new patients
Southern Physical Therapy, LLC Physical Therapist Past Accepting new patients
Independent Physical Therapy LLC Physical Therapist Past Accepting new patients

Locations

1340 S Main St
Ste 100
Grapevine, TX 76051
Phone (682) 651-1908

3509 Spectrum Blvd
#B
Richardson, TX 75082
Phone (972) 772-9600

3142 Horizon Rd
Ste 100
Rockwall, TX 75032
Phone (682) 651-1908

1545 E Southlake Blvd
Southlake, TX 76092
Phone (817) 557-8205

1545 E Southlake Blvd
Ste 100
Southlake, TX 76092

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1942335948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926422",
            "telephone_number": "817-442-9300",
            "fax_number": "817-796-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 E SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926422",
            "telephone_number": "817-442-9300",
            "fax_number": "817-796-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LETTIERE",
        "first_name": "ANNETTE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1162725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPIST LICENS",
            "identifier": "1162725",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stt@116.direct.myezyaccess.com",
            "affiliation": "N",
            "address_1": "1545 E Southlake Blvd",
            "address_2": "Suite 100",
            "city": "Southlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760926422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; 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.