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

Tiesha Shakema Fenwick

Individual provider Physical Therapist · NPI 1215820188

Tiesha Shakema Fenwick is a Physical Therapist in Private Practice in Fort Worth, Texas. Qualified in 2024, 2 years ago. Practices with Ideal Physical Therapy of Texas LLC, a 360-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Texas and Virginia.

Years since qualifying
2
Licensed in
TX, VA
In the registry since
2025
Specialties on file
2
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Practice location Address checks out

4617 W Bailey Boswell Rd
Fort Worth, TX 76179-4327
Phone: (682) 350-4206
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4617 W Bailey Boswell Rd, Fort Worth, TX 76179-4327 — (972) 979-6577

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 1406799 (TX)
Physical Therapist Taxonomy 225100000X · Licence 2305217040 (VA)

Record details

NPI number1215820188
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 30, 2025
Last updated in NPPESJune 9, 2025
Certification dateJune 9, 2025
Mailing address2001 Butterfield Rd Ste 1600, Downers Grove, IL 60515-1211

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Ideal Physical Therapy Of Texas Llc — 360 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Fort Worth