Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

DR. BLAINE MICHAEL THEODOS
NPI 1730019720
Physical Therapist in Shreveport, LA

Active since May 21, 2026
663 JORDAN ST, SHREVEPORT, LA 71101(318) 222-8892 Get Directions Write a Review

NPPES record added: May 22, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Blaine Michael Theodos NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BLAINE MICHAEL THEODOS (NPI 1730019720) is an individual physical therapist in Shreveport, Louisiana, licensed in Louisiana (12329) and active in the NPI registry since May 2026. He is a graduate of Other (2026).

NPPES Registry Identity

NPI1730019720
Entity TypeIndividualMale
Primary Taxonomy225100000X
Provider Legal NameDR. BLAINE MICHAEL THEODOS
Location Address663 JORDAN STShreveport, LA 71101-4748
Mailing Address663 Jordan StShreveport, LA 71101-4748 · (318) 222-8892 · Fax (318) 222-8893
Sole ProprietorNo
Medical School CMSOtherGraduated 2026
Enumeration DateMay 21, 2026
Last NPPES UpdateMay 22, 2026
NPPES CertifiedMay 22, 2026
NPI 1730019720 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
License Licensed in LA · 12329
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
663 JORDAN ST, Shreveport, LA 71101

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Dr. Blaine Michael Theodos is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1850862434
PECOS Enrollment IDI20260604001502

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapist (Orthopedic)
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101
Physical Therapist
663 JORDAN ST
SHREVEPORT, LA 71101

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 Blaine Theodos's NPI number?

The NPI number for Blaine Theodos is 1730019720. It was assigned to this individual provider in the NPPES registry on May 21, 2026.

Where is Blaine Theodos located?

Blaine Theodos practices at 663 Jordan St, Shreveport, LA 71101. The listed phone number is (318) 222-8892.

What is Blaine Theodos's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Is Blaine Theodos enrolled in Medicare?

Yes. Blaine Theodos is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Blaine Theodos was last updated on May 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.