Active NPI
David Jay Lyons, MPT
- Physical Therapist
- Traverse City, MI
National Provider Identifier
1407906241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501013874
- Practice address
- 1225 W Front St
Traverse City, MI 49684-2368 - Phone
- (231) 935-0788
- Fax
- (231) 935-0787
- NPI assigned
- Jan 12, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501013874 | MI | Primary |
Addresses
Primary practice location
1225 W Front St
Traverse City, MI 49684-2368
Mailing address
1225 W Front St
Traverse City, MI 49684-2368
Phone (231) 935-0788
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Provemont Family Care, PLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Primary Care Clinic/Center
- Lake Leelanau, MI
- NPI 1013109214
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347667200000",
"number": "1407906241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 W FRONT ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842368",
"telephone_number": "231-935-0788",
"fax_number": "231-935-0787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 W FRONT ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842368",
"telephone_number": "231-935-0788",
"fax_number": "231-935-0787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYONS",
"first_name": "DAVID",
"middle_name": "JAY",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2012-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501013874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.