Taylor Ravoyd Liles, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

2630 Central Ave
Eielson AFB, AK 99702-2301

Phone

(907) 377-6631

NPI assigned

Jan 13, 2021

Last updated

Sep 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantage Physical Therapy LLCGroup PAC ID 3173034014, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: taylor.liles.1@20934.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Soldotna, AK
  • NPI 1447973219
  Medicare reassignment Care Compare group NPD
• Select Physical Therapy Holdings Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Eagle River, AK
  • NPI 1699743484

  Physical Therapist

  Medicare reassignment NPD
• Therapist Central, Inc.

  dba Seawolf Physical Therapy

  • Physical Therapy Clinic/Center
  • Anchorage, AK
  • NPI 1700074382

  Physical Therapist

  Medicare reassignment NPD
• Select Physical Therapy Holdings, Inc.

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Kenai, AK
  • NPI 1366083941
  NPD
• Select Physical Therapy Holdings Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Ashland, VA
  • NPI 1174591218
  NPD

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1699364877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022301",
            "telephone_number": "907-377-6631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILES",
        "first_name": "TAYLOR",
        "middle_name": "RAVOYD",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-13",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "174385",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1377738",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachery Lavender, IDMT-P
• Danielle A Lawson
• Theresa Ann Lawson, PH.D.
• Cody Scott Lemon
• Susan Liebig, RDH
• Julianne Marie Lujan, IDMT
• Turner Arizona Macphee, DPT
• Bradley Martin
• Eric Dylan Mason, IDMT
• Karen L Medbury, MSW, LCSW

• Physical Therapist in Eielson AFB, AK
• Providers in Eielson AFB, AK by specialty
• Physical Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.