Individual provider Active NPI

Jennifer Marie Tyra, PT, DPT

  • Physical Therapist
  • Newnan, GA
National Provider Identifier
1518483411
Registry record updated Nov 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1755 Highway 34 E
Ste 1300
Newnan, GA 30265-3186
Phone
(770) 254-7850
NPI assigned
Aug 22, 2017
Last updated
Nov 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X GA Primary

Addresses

Primary practice location

1755 Highway 34 E
Ste 1300
Newnan, GA 30265-3186

Mailing address

1755 Highway 34 E
Ste 1300
Newnan, GA 30265-3186
Phone (770) 254-7850

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

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541980800000",
    "number": "1518483411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 HIGHWAY 34 E",
            "address_2": "STE 1300",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302653186",
            "telephone_number": "770-254-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 HIGHWAY 34 E",
            "address_2": "STE 1300",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302653186",
            "telephone_number": "770-254-7850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYRA",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-22",
        "last_updated": "2018-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.