Active NPI
Tyler William Maharrey, PTA
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Jasper, IN
National Provider Identifier
1366084915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 06005989A
- Practice address
- 600 W 13TH St
Jasper, IN 47546-1881 - Phone
- (812) 482-7441
- NPI assigned
- Oct 15, 2019
- 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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 06005989A | IN | Primary |
Addresses
Primary practice location
600 W 13TH St
Jasper, IN 47546-1881
Mailing address
998 S State Road 61
Winslow, IN 47598-8455
Phone (812) 582-0997
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
| License | State | Type | Specialty |
|---|---|---|---|
| 06005989A | IN | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571097600000",
"number": "1366084915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "998 S STATE ROAD 61",
"city": "WINSLOW",
"state": "IN",
"postal_code": "475988455",
"telephone_number": "812-582-0997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 W 13TH ST",
"city": "JASPER",
"state": "IN",
"postal_code": "475461881",
"telephone_number": "812-482-7441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHARREY",
"first_name": "TYLER",
"middle_name": "WILLIAM",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-15",
"last_updated": "2019-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "IN",
"license": "06005989A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jasper, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.