Protailored Physical Therapy LLC
NPI 1063805042 · Orthopedic Physical Therapist · Fort Wayne, IN
Enrolled with Medicare as Part B Supplier - Physical/Occupational Therapy Group in Private Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Protailored Physical Therapy LLC is a Orthopedic Physical Therapist organization in Fort Wayne, IN (NPI 1063805042).
Provider details
- NPI number
- 1063805042
- Entity type
- Organization
- Primary specialty
- Orthopedic Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Jonathan Evans, Physical Therapist/Owner(260) 570-8239
- License
- 05011654A (IN)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2015-03-14
- Last updated
- 2020-06-01
- Certified
- 2020-06-01
Frequently asked questions
- What is Protailored Physical Therapy LLC's NPI number?
- Protailored Physical Therapy LLC's National Provider Identifier (NPI) is 1063805042, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Protailored Physical Therapy LLC?
- Protailored Physical Therapy LLC is classified in the NPPES registry as Orthopedic Physical Therapist (Respiratory, Developmental, Rehabilitative and Restorative Service Providers).
- Where is Protailored Physical Therapy LLC located?
- Protailored Physical Therapy LLC's practice location on file with NPPES is 12722 Tonkel Rd Ste 102, Fort Wayne, IN 46845-8201.
- What is Protailored Physical Therapy LLC's phone number?
- The practice phone number listed in the NPPES registry for Protailored Physical Therapy LLC is (260) 739-0300.
- Does Protailored Physical Therapy LLC accept Medicare?
- Protailored Physical Therapy LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Protailored Physical Therapy LLC?
- The authorized official listed on Protailored Physical Therapy LLC's NPPES record is Jonathan Evans, Physical Therapist/Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Protailored Physical Therapy LLC's NPI active?
- Yes — Protailored Physical Therapy LLC's NPI (1063805042) is active in the NPPES registry as of the last update on 2020-06-01.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.