Active NPI
Tyra Holliday, DPT
- Physical Therapist
- Waldorf, MD
National Provider Identifier
1821860834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- CP025717T
- Practice address
- 3320 Crain Hwy
Waldorf, MD 20603-4850 - Phone
- (301) 870-7366
- NPI assigned
- Oct 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | CP025717T | MD | Primary |
| Physical Therapist | 225100000X | PT015946 | GA |
Addresses
Primary practice location
3320 Crain Hwy
Waldorf, MD 20603-4850
Mailing address
655 S Willow St Ste 128
Manchester, NH 03103-5723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231121001643 | MD | Practitioner - Physical Therapist in Private Practice | 4183072739 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT015946 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698192000000",
"number": "1821860834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 S WILLOW ST STE 128",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031035723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3320 CRAIN HWY",
"city": "WALDORF",
"state": "MD",
"postal_code": "206034850",
"telephone_number": "301-870-7366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIDAY",
"first_name": "TYRA",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-23",
"last_updated": "2023-10-25",
"certification_date": "2023-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "CP025717T",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT015946",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.