Individual provider Active NPI

Peyton Elizabeth Lassley, PT, DPT

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1053080101
Registry record updated Sep 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT37715 Issued in FL
Practice address
11512 Lake Mead Ave Unit 604
Jacksonville, FL 32256-9686
Phone
(904) 652-5408
NPI assigned
Sep 12, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT37715 FL Primary

Addresses

Primary practice location

11512 Lake Mead Ave Unit 604
Jacksonville, FL 32256-9686

Mailing address

4860 Trumbull PL
Jacksonville, FL 32257-4579

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

LicenseStateTypeSpecialty
PT37715FLMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631404800000",
    "number": "1053080101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4860 TRUMBULL PL",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322574579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE UNIT 604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569686",
            "telephone_number": "904-652-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASSLEY",
        "first_name": "PEYTON",
        "middle_name": "ELIZABETH",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-12",
        "last_updated": "2021-09-12",
        "certification_date": "2021-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT37715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.

Verify at the official NPI Registry.