Mary Lesie Kyzer, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1383 Issued in GA

Practice address

101 Harris Industrial Blvd
Vidalia, GA 30474

Phone

(912) 277-2044

NPI assigned

May 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619187002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LAKEVIEW DR",
            "city": "WRIGHTSVILLE",
            "state": "GA",
            "postal_code": "310961836",
            "telephone_number": "478-864-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HARRIS INDUSTRIAL BLVD",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-277-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYZER",
        "first_name": "MARY",
        "middle_name": "LESIE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA1383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Archie Thomas Kirkley, PA-C
• Sarah B Kitchens, LPC
• Tosaporn Krasaeath, MD
• Kimberly A Krupack, DPT
• Kurt P Hofmann MD LLC
• Jessica Leigh Langenfeld, FNP-C
• Lashonda Monique Lanier-Jenkins, REGISTERED NURSE
• Abbey Lanier, OTR/L
• Amanda Lariscey, PA-C
• Steven Michael Lashley, FNP

• Physical Therapy Assistant in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.