Active NPI
Tyler Clyde Condon, DPT
- Physical Therapist
- Andover, KS
National Provider Identifier
1467714451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1104396
- Practice address
- 550 N Andover Rd
Andover, KS 67002-9712 - Phone
- (316) 202-0195
- Fax
- (316) 202-0196
- NPI assigned
- Jun 14, 2012
- Last updated
- Nov 15, 2013
- 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 | 1104396 | KS | Primary |
Addresses
Primary practice location
550 N Andover Rd
Andover, KS 67002-9712
Mailing address
200 W Douglas Ave
Ste 1040
Wichita, KS 67202-3013
Phone (316) 263-0003
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104396 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced PT Pca, LLC | Physical Therapist | 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, 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": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1467714451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 W DOUGLAS AVE",
"address_2": "STE 1040",
"city": "WICHITA",
"state": "KS",
"postal_code": "672023013",
"telephone_number": "316-263-0003",
"fax_number": "316-263-1241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 N ANDOVER RD",
"city": "ANDOVER",
"state": "KS",
"postal_code": "670029712",
"telephone_number": "316-202-0195",
"fax_number": "316-202-0196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONDON",
"first_name": "TYLER",
"middle_name": "CLYDE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "1104396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.