Active NPI
Lodie Nycol Kyzar, P.T.
- Pediatric Physical Therapist
- Bossier City, LA
National Provider Identifier
1780947440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 07803
- Practice address
- 536 Half Moon LN
Bossier City, LA 71111-5576 - Phone
- (318) 623-2014
- NPI assigned
- Jun 18, 2012
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 07803 | LA | Primary |
Addresses
Primary practice location
536 Half Moon LN
Bossier City, LA 71111-5576
Mailing address
536 Half Moon LN
Bossier City, LA 71111-5576
Phone (318) 623-2014
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07803 | LA | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339977600000",
"number": "1780947440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "536 HALF MOON LN",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711115576",
"telephone_number": "318-623-2014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 HALF MOON LN",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711115576",
"telephone_number": "318-623-2014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KYZAR",
"first_name": "LODIE",
"middle_name": "NYCOL",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-18",
"last_updated": "2012-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "LA",
"license": "07803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.