Active NPI
Lisa Joy Deyoung, P.T.
- Physical Therapist
- Yadkinville, NC
National Provider Identifier
1841230596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5876
- Practice address
- 102 Woodlyn Dr
Yadkinville, NC 27055-6673 - Phone
- (336) 677-1800
- Fax
- (336) 677-1802
- NPI assigned
- Jun 8, 2006
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5876 | NC | Primary |
Addresses
Primary practice location
102 Woodlyn Dr
Yadkinville, NC 27055-6673
Mailing address
1936 Waccamaw Path
Winston Salem, NC 27127-9433
Phone (336) 788-4225
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7213013 | Medicaid | NC |
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 |
|---|---|---|---|
| 5876 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475971200000",
"number": "1841230596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1936 WACCAMAW PATH",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271279433",
"telephone_number": "336-788-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 WOODLYN DR",
"city": "YADKINVILLE",
"state": "NC",
"postal_code": "270556673",
"telephone_number": "336-677-1800",
"fax_number": "336-677-1802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEYOUNG",
"first_name": "LISA",
"middle_name": "JOY",
"name_prefix": "Ms.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-08",
"last_updated": "2016-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "5876",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7213013",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yadkinville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.