Active NPI
Tyler Donald Bolley, DPT
- Physical Therapist
- Plymouth, MI
National Provider Identifier
1003120320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501015257
- Practice address
- 9368 N Lilley Rd
Plymouth, MI 48170-4610 - Phone
- (734) 416-3900
- Fax
- (734) 416-3903
- NPI assigned
- Jul 28, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501015257 | MI | Primary |
Addresses
Primary practice location
9368 N Lilley Rd
Plymouth, MI 48170-4610
Mailing address
9368 N Lilley Rd
Plymouth, MI 48170-4610
Phone (734) 416-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1003120320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9368 N LILLEY RD",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481704610",
"telephone_number": "734-416-3900",
"fax_number": "734-416-3903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9368 N LILLEY RD",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481704610",
"telephone_number": "734-416-3900",
"fax_number": "734-416-3903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLEY",
"first_name": "TYLER",
"middle_name": "DONALD",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-07-28",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501015257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.