Individual provider Active NPI

Michelle Tyler Williams, DPT

  • Physical Therapist
  • Towanda, PA
National Provider Identifier
1225067754
Registry record updated Sep 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015379 Issued in PA
Practice address
24569 Route 6 Ste C
Towanda, PA 18848-8254
Phone
(570) 265-7688
Fax
(570) 265-7422
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X DAPT000033 PA
Registered Respiratory Therapist 227900000X RT003029 PA
Physical Therapist 225100000X PT015379 PA Primary

Addresses

Primary practice location

24569 Route 6 Ste C
Towanda, PA 18848-8254

Mailing address

350 New Fidelity CT
Garner, NC 27529-2665
Phone (919) 258-2714

Other identifiers 2

IdentifierTypeStateIssuer
PT015379OtherPASTATE LICENSE
817151OtherFIRST PRIORITY HEALTH

Other names 1

  • Michelle Tyler Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111228000057 PA Practitioner - Physical Therapist in Private Practice 2769658624 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DAPT000033PAMDPhysical Therapist
PT015379PAMDPhysical Therapist
RT003029PAMDRegistered Respiratory Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pivot Physical Therapy of Pennsylvania, LLC Physical Therapist CurrentSince Jun 1, 2017 Accepting new patients
Dynamic Therapy Services, LLC Physical Therapist Past Accepting new patients

Locations

350 New Fidelity Ct
Garner, NC 27529
Phone (919) 373-2919

328 Market St
Lewisburg, PA 17837
Phone (570) 768-4922

417 Grow Ave
Montrose, PA 18801
Phone (570) 278-1101

208 S Main St
Moscow, PA 18444
Phone (570) 842-8191

655 Northern Blvd
South Abington Township, PA 18411
Phone (570) 587-2142

24569 Route 6
#C
Towanda, PA 18848
Phone (570) 265-1111

24569 Route 6
Towanda, PA 18848
Phone (570) 265-7688

130 W Main St
Ste 100B
Trappe, PA 19426
Phone (484) 471-6850

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1225067754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 NEW FIDELITY CT",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292665",
            "telephone_number": "919-258-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24569 ROUTE 6 STE C",
            "city": "TOWANDA",
            "state": "PA",
            "postal_code": "188488254",
            "telephone_number": "570-265-7688",
            "fax_number": "570-265-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MICHELLE",
        "middle_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "DAPT000033",
            "primary": false
        },
        {
            "code": "227900000X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered",
            "state": "PA",
            "license": "RT003029",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT015379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT015379",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "817151",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "TYLER",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Towanda, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.