Active NPI
Holden Lyman, PTA
- Physical Therapy Assistant
- St George, UT
National Provider Identifier
1023684164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 12284420-2402
- Practice address
- 4617 S Pioneer Rd Ste 103
St George, UT 84790-5156 - Phone
- (435) 767-9096
- NPI assigned
- May 30, 2021
- 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 Therapy Assistant | 225200000X | 12284420-2402 | UT | Primary |
Addresses
Primary practice location
4617 S Pioneer Rd Ste 103
St George, UT 84790-5156
Mailing address
844 W Tramonto St
Washington, UT 84780-3191
Phone (435) 799-1186
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12284420-2402 | UT | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622332800000",
"number": "1023684164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "844 W TRAMONTO ST",
"city": "WASHINGTON",
"state": "UT",
"postal_code": "847803191",
"telephone_number": "435-799-1186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4617 S PIONEER RD STE 103",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847905156",
"telephone_number": "435-767-9096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYMAN",
"first_name": "HOLDEN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-30",
"last_updated": "2021-05-30",
"certification_date": "2021-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "UT",
"license": "12284420-2402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.