Active NPI
Tyler Van Bastian, DPT
- Physical Therapist
- Albuquerque, NM
National Provider Identifier
1558979245
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT5730
- Practice address
- 2100 Louisiana Blvd NE Ste 410
Albuquerque, NM 87110-5412 - Phone
- (505) 724-4300
- NPI assigned
- Jul 19, 2020
- Last updated
- Jul 19, 2020
- 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 | PT5730 | NM | Primary |
Addresses
Primary practice location
2100 Louisiana Blvd NE Ste 410
Albuquerque, NM 87110-5412
Mailing address
5120 Alberta Ave NE
Rio Rancho, NM 87144-6482
Phone (505) 615-6368
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 |
|---|---|---|---|
| PT5730 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595116800000",
"number": "1558979245",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5120 ALBERTA AVE NE",
"city": "RIO RANCHO",
"state": "NM",
"postal_code": "871446482",
"telephone_number": "505-615-6368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 LOUISIANA BLVD NE STE 410",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871105412",
"telephone_number": "505-724-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BASTIAN",
"first_name": "TYLER",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-19",
"last_updated": "2020-07-19",
"certification_date": "2020-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "PT5730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.