PROTAILORED PHYSICAL THERAPY LLC
NPI 1063805042
Physical Therapist - Orthopedic in Fort Wayne, IN
About Protailored Physical Therapy Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROTAILORED PHYSICAL THERAPY LLC (NPI 1063805042) is a healthcare organization registered as an orthopedic in Fort Wayne, Indiana and active in the NPI registry since March 2015. The organization lists Jonathan T Evans, Physical Therapist/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Protailored Physical Therapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
24Medicare enrollment records show 24 clinicians reassign Medicare billing to Protailored Physical Therapy LLC, which bills Medicare for the services they deliver. Of these, 17 practice at this address. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 2
Nearest to this location (20)
See all 24Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Protailored Physical Therapy LLC's NPI number?
The NPI number for Protailored Physical Therapy LLC is 1063805042. It was assigned to this organization in the NPPES registry on March 14, 2015.
Where is Protailored Physical Therapy LLC located?
Protailored Physical Therapy LLC is located at 12722 Tonkel Rd Ste 102, Fort Wayne, IN 46845. The listed phone number is (260) 739-0300.
What is Protailored Physical Therapy LLC's specialty?
The primary specialty registered for this NPI is Physical Therapist, specializing in Orthopedic, with taxonomy code 2251X0800X.
Is Protailored Physical Therapy LLC enrolled in Medicare?
Yes. Protailored Physical Therapy LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Protailored Physical Therapy LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 24 clinicians in 2 Medicare specialties reassign their Medicare billing to Protailored Physical Therapy LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Physical Therapist in Private Practice (21) and Occupational Therapist in Private Practice (3). Of these, 17 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Protailored Physical Therapy LLC accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Protailored Physical Therapy LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Protailored Physical Therapy LLC was last updated on June 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Protailored Physical Therapy Llc · NPI 1063805042
Orthopedic organization in Fort Wayne, Indiana. Organization record, active in the CMS NPPES registry since March 14, 2015.
## Identity
- **NPI:** 1063805042 (Entity type: Organization)
- **Enumerated:** March 14, 2015
- **Primary specialty:** Physical Therapist - Orthopedic · taxonomy 2251X0800X
- **Organization subpart:** No
- **Authorized official:** Jonathan Evans, PHYSICAL THERAPIST/OWNER
## Practice location
- **Address:** 12722 TONKEL RD STE 102, Fort Wayne, IN 46845-8201
- **Phone:** (260) 739-0300 · **Fax:** (260) 818-2299
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 24 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Physical Therapist in Private Practice (21), Occupational Therapist in Private Practice (3); 17 practice at this address; [full list](https://npiprofile.com/npi/1063805042/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 1, 2020
- **Other identifiers:** Medicaid 201289250A (IN)
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Source: [NPI Profile](https://npiprofile.com/npi/1063805042) · Data from the CMS NPPES public registry.