| Tillman Physical Therapy & Sports Training Center, Inc | |
|
2519 S Lakeline Blvd Suite 100 Cedar Park TX 78613-2964 | |
| (512) 331-6200 | |
| (512) 331-4312 |
| Full Name | Tillman Physical Therapy & Sports Training Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2519 S Lakeline Blvd, Cedar Park, Texas |
| Authorized Official Name and Position | Michael Ray Tillman (PHYICAL THERAPIST PRESIDENT) |
| Authorized Official Contact | 5123316200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tillman Physical Therapy & Sports Training Center, Inc 2519 S Lakeline Blvd Suite 100 Cedar Park TX 78613-2964 Ph: (512) 331-6200 | Tillman Physical Therapy & Sports Training Center, Inc 2519 S Lakeline Blvd Suite 100 Cedar Park TX 78613-2964 Ph: (512) 331-6200 |
| NPI Number | 1376579797 |
|---|---|
| Provider Enumeration Date | 06/25/2006 |
| Last Update Date | 03/17/2011 |
| Medicare PECOS PAC ID | 9638240773 |
|---|---|
| Medicare Enrollment ID | O20080618000271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376579797 | NPI | - | NPPES |
| 153870401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 554280000 (Texas) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | 644350000 (Texas) | Primary |
| Provider Name | Michael Ray Tillman |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1376571919 PECOS PAC ID: 1355412396 Enrollment ID: I20080819000874 |
| Provider Name | Cheryl Faubion Thomas |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154576767 PECOS PAC ID: 8628131588 Enrollment ID: I20090120000621 |
| Provider Name | Adam Michael Smithers |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588030209 PECOS PAC ID: 2567770878 Enrollment ID: I20151007001106 |
| Provider Name | Karen Hoffman |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164468518 PECOS PAC ID: 1456438662 Enrollment ID: I20151119000024 |
| Provider Name | Scott Herbowy |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346794096 PECOS PAC ID: 9032490156 Enrollment ID: I20170104001480 |
| Provider Name | Ashen Mohammed |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1134765803 PECOS PAC ID: 8325472731 Enrollment ID: I20191218000062 |
| Provider Name | Daniel Mendoza |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1629686738 PECOS PAC ID: 5890110670 Enrollment ID: I20200811001316 |
| Provider Name | Heather Renae Marshall |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124630769 PECOS PAC ID: 4082024286 Enrollment ID: I20201028003170 |
| Provider Name | Danielle Raye Hildom |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477128320 PECOS PAC ID: 0446651244 Enrollment ID: I20210630003827 |
| Provider Name | Kristen Munoz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467056283 PECOS PAC ID: 4587069067 Enrollment ID: I20210820002759 |
| Provider Name | Macey Glowczwski |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598338931 PECOS PAC ID: 1951707967 Enrollment ID: I20210831000181 |
| Provider Name | Kendall Mcginty |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144801135 PECOS PAC ID: 0941606909 Enrollment ID: I20210831001938 |
| Provider Name | Brad Giang |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1386355881 PECOS PAC ID: 4688032287 Enrollment ID: I20230614000062 |
| Provider Name | Sharon Ann Vasser |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265214852 PECOS PAC ID: 2860840121 Enrollment ID: I20231127002161 |
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