Active NPI
Tyler Smith, DPT
- Physical Therapist
- Venice, CA
National Provider Identifier
1811596869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT298820
- Practice address
- 1600 Main St FL 2
Venice, CA 90291-3626 - Phone
- (888) 859-0145
- Fax
- (888) 858-1601
- NPI assigned
- Oct 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT298820 | CA | Primary |
Addresses
Primary practice location
1600 Main St FL 2
Venice, CA 90291-3626
Mailing address
3040 Paula Dr
Santa Monica, CA 90405-5823
Phone (323) 540-4552
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT298820 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1811596869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3040 PAULA DR",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904055823",
"telephone_number": "323-540-4552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 MAIN ST FL 2",
"city": "VENICE",
"state": "CA",
"postal_code": "902913626",
"telephone_number": "888-859-0145",
"fax_number": "888-858-1601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "TYLER",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-21",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT298820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Venice, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.