Active NPI
Lee Nathan Lysiuk, MS, LAT, ATC
- Athletic Trainer
- Noblesville, IN
National Provider Identifier
1083662761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36001149A
- Practice address
- 18111 Cumberland Rd
Noblesville, IN 46060-5650 - Phone
- (317) 417-8689
- NPI assigned
- May 4, 2006
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36001149A | IN | Primary |
Addresses
Primary practice location
18111 Cumberland Rd
Noblesville, IN 46060-5650
Mailing address
10752 Chestnut Heath CT
Noblesville, IN 46060-6117
Phone (317) 417-8689
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36001149A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721260800000",
"number": "1083662761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10752 CHESTNUT HEATH CT",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460606117",
"telephone_number": "317-417-8689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18111 CUMBERLAND RD",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460605650",
"telephone_number": "317-417-8689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSIUK",
"first_name": "LEE",
"middle_name": "NATHAN",
"name_prefix": "Mr.",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2024-07-18",
"certification_date": "2024-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36001149A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Noblesville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.