PROTAILORED PHYSICAL THERAPY LLC NPI 1063805042

NPI Information

  • NPI: 1063805042
  • Provider Name: PROTAILORED PHYSICAL THERAPY LLC
  • Classification: Physical Therapist - 2251X0800X
  • Specialization: Orthopedic
  • Entity Type: Organization
  • Address: 12722 TONKEL RD STE 102
    FORT WAYNE, IN
    ZIP 46845
  • Phone: (260) 739-0300

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NPI Details

PROTAILORED PHYSICAL THERAPY LLC is an orthopedic physical therapist in Fort Wayne, IN. The provider is a licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Orthopaedic Physical Therapy, who has demonstrated specialized knowledge and skill in human anatomy and physiology, movement science; pathology/pathophysiology, pain science, medical and surgical considerations, orthopaedic physical therapy theory and practice, and critical inquiry for evidence-based practice. PROTAILORED PHYSICAL THERAPY LLC NPI is 1063805042. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

12722 TONKEL RD STE 102
FORT WAYNE, IN
ZIP 46845-201
Phone: (260) 739-0300
Fax: (260) 818-2299

The provider's authorized official is Jonathan T Evans .
The authorized official title is Physical Therapist/owner and has the following contact phone number (260) 570-8239.

The enumeration date for this NPI number is 3/14/2015 and was last updated on 6/1/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12251X0800XPhysical TherapistOrthopedic05011654AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1201289250AMEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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