Lydia D Anderson, DPT
Individual provider Active NPI Physical Therapist · Edmond, OK
NPI 1609381979 · NPPES record last updated Jul 5, 2019
Key facts
- NPI
- 1609381979
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 23611 (MA)
- Practice address
- 3224 Orchard Ave
Edmond, OK 73012-9645 - Phone
- (719) 244-8147
- Fax
- (719) 244-8147
- NPI assigned
- Dec 8, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bay State Physical Therapy of Randolph Inc
Practice addresses (Care Compare)
186 Great Rd
Bedford, MA 01730-2710
Phone (617) 730-5337
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190903002356 | MA | Practitioner - Physical Therapist in Private Practice | 4486913118 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23611 | MA | MD | Pharmacist |
| 5383 | OK | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 23611 | MA | Yes |
Addresses
Primary practice location
3224 Orchard Ave
Edmond, OK 73012-9645
Mailing address
1180 Beacon St
Ste 6C
Brookline, MA 02446-3806
Phone (719) 244-8147
NPI Registry JSON
{
"created_epoch": "1512691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562284800000",
"number": "1609381979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1180 BEACON ST",
"address_2": "STE 6C",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "024463806",
"telephone_number": "719-244-8147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3224 ORCHARD AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730129645",
"telephone_number": "719-244-8147",
"fax_number": "719-244-8147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "LYDIA",
"middle_name": "D",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-08",
"last_updated": "2019-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "23611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
- Cheyenne Blu Anderson
- Cody M. Anderson
- Katherine Nicole Anderson
- Lacey Snow Anderson
- Lauren Anderson
- Matelean Anderson
- Micheal Anderson
- Natassia Anderson
- Savanna Anderson
- Andrade Medical Services
All providers in Edmond, OK · Physical Therapist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.