Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Blaine Michael Theodos

Individual provider Physical Therapist · NPI 1730019720

Dr. Blaine Michael Theodos is a Physical Therapist in Private Practice in Shreveport, Louisiana. Licensed in Louisiana. Registered with an NPI since 2026.

Licensed in
LA
In the registry since
2026

Practice location Address checks out

663 Jordan St
Shreveport, LA 71101-4748
Phone: (318) 222-8892
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 12329 (LA)

Record details

NPI number1730019720
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 21, 2026
Last updated in NPPESMay 22, 2026
Certification dateMay 22, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2026 (0 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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