NPIMap

Organization Active NPI

Lonestar Physical Therapy & Sports Performance LLC

  • Orthopedic Physical Therapist
  • Tyler, TX
National Provider Identifier
1326779323
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Legal business name
LONESTAR PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Practice address
5759 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6231
Phone
(903) 405-4899
Fax
(903) 638-2741
NPI assigned
Jun 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Dr. Stephen Swygert Ford, PT, DPT, OCS, CSCSNPI 1588150270
Title
Chief Executive Officer
Phone
(903) 274-9977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Ergonomics Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251E1200X
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X Primary
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X

Addresses

Primary practice location

5759 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6231

Mailing address

5759 Eagles Nest Blvd Ste 4
Tyler, TX 75703-6231
Phone (903) 405-4899

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221207002979 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698144954 Receives reassigned benefits from 3 practitioners
Practice locations: Tyler, TX

National Provider Directory

National Provider Directory

Locations

5759 Eagles Nest Blvd
Ste 4
Tyler, TX 75703
Phone (903) 405-4899

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1326779323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5759 EAGLES NEST BLVD STE 4",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757036231",
            "telephone_number": "903-405-4899",
            "fax_number": "903-638-2741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5759 EAGLES NEST BLVD STE 4",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757036231",
            "telephone_number": "903-405-4899",
            "fax_number": "903-638-2741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONESTAR PHYSICAL THERAPY & SPORTS PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-21",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "SWYGERT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "903-274-9977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, OCS, CSCS"
    },
    "taxonomies": [
        {
            "code": "2251E1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Ergonomics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.