Tristan Zachary Lucy-Speidel, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

28984 Issued in MD

Practice address

110 W Timonium Rd
Timonium, MD 21093-7300

Phone

(443) 997-5476

NPI assigned

Jan 29, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1629532197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202004",
            "telephone_number": "410-933-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W TIMONIUM RD",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210937300",
            "telephone_number": "443-997-5476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "187 Pine Tree Ln",
            "address_purpose": "LOCATION",
            "city": "Fort Valley",
            "state": "VA",
            "postal_code": "226523221",
            "country_code": "US",
            "telephone_number": "540-933-6399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LUCY-SPEIDEL",
        "first_name": "TRISTAN",
        "middle_name": "ZACHARY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-29",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28984",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VI",
            "license": "T64435205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Timonium, MD
• Providers in Timonium, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; 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.