Protailored Physical Therapy LLC
NPI 1063805042ActiveOrganization· Physical Therapist, Orthopedic· Fort Wayne, IN
Physical Therapist, Orthopedic in Fort Wayne, Indiana, registered in NPPES in March 2015. The authorized official on file is Jonathan T. Evans, PT, DPT, Physical Therapist/Owner. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1063805042 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 14, 2015 |
| Last updated in NPPES | Jun 1, 2020 |
| Certified by provider | Jun 1, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist, Orthopedic Primary | 2251X0800X | 05011654A | IN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Physical/Occupational Therapy Group in Private Practice (IN) |
|---|
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