Active NPI
Tyler Waterway, DPT
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1487385043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501302073
- Practice address
- 2500 E Beltline Ave SE Ste J
Grand Rapids, MI 49546-5987 - Phone
- (616) 855-6588
- NPI assigned
- Jun 23, 2022
- Last updated
- Jun 23, 2022
- 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 | 5501302073 | MI | Primary |
Addresses
Primary practice location
2500 E Beltline Ave SE Ste J
Grand Rapids, MI 49546-5987
Mailing address
5135 Hide Away LN
Hudsonville, MI 49426-7373
Phone (616) 610-4273
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 |
|---|---|---|---|
| 5501302073 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655942400000",
"number": "1487385043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5135 HIDE AWAY LN",
"city": "HUDSONVILLE",
"state": "MI",
"postal_code": "494267373",
"telephone_number": "616-610-4273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 E BELTLINE AVE SE STE J",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495465987",
"telephone_number": "616-855-6588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERWAY",
"first_name": "TYLER",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-23",
"last_updated": "2022-06-23",
"certification_date": "2022-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501302073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.