Individual provider Active NPI

Tyler James Wyant, DPT

  • Physical Therapist
  • Kearney, NE
National Provider Identifier
1083949507
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2755 Issued in NE
Practice address
211 W 33Rd St Ste a
Kearney, NE 68845-3485
Phone
(308) 236-5884
Fax
(308) 236-9621
NPI assigned
Oct 16, 2009
Last updated
Oct 24, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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 2755 NE Primary

Addresses

Primary practice location

211 W 33Rd St Ste a
Kearney, NE 68845-3485

Mailing address

211 W 33Rd St Ste a
Kearney, NE 68845-3485
Phone (308) 236-5884

Other identifiers 2

IdentifierTypeStateIssuer
2755OtherNELICENSE
47598OtherNEBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100106000667 NE Practitioner - Physical Therapist in Private Practice 9436290988 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

211 W 33Rd St
Suite a
Kearney, NE 68845-3485
Phone (308) 236-5884

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2755NEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family Physical Therapy & Sports Center CurrentSince Jun 6, 2011 Accepting new patients
Family Physical Therapy & Sports Center Physical Therapist CurrentSince Jun 6, 2011 Accepting new patients
Advanced Prosthetics Center LLC Physical Therapist PastSince Aug 2, 2013 Accepting new patients
Family Physical Therapy & Sports Center Physical Therapist Past Accepting new patients

Locations

211 W 33rd St
Ste A
Kearney, NE 68845
Phone (308) 236-5884

3500 Central Ave
Ste C1
Kearney, NE 68847
Phone (308) 865-9200

110 W 5th St
Lexington, NE 68850
Phone (308) 324-3700

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1083949507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W 33RD ST STE A",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688453485",
            "telephone_number": "308-236-5884",
            "fax_number": "308-236-9621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W 33RD ST STE A",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688453485",
            "telephone_number": "308-236-5884",
            "fax_number": "308-236-9621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYANT",
        "first_name": "TYLER",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-16",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NE",
            "license": "2755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2755",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "47598",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.