Active NPI
Angel Ly, ATC, LAT
- Athletic Trainer
- Tampa, FL
National Provider Identifier
1871008169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL4485
- Practice address
- 4202 E Fowler Ave Stop Ath100
Tampa, FL 33620-8455 - Phone
- (813) 974-0661
- NPI assigned
- Dec 8, 2017
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL4485 | FL | Primary |
Addresses
Primary practice location
4202 E Fowler Ave Stop Ath100
Tampa, FL 33620-8455
Mailing address
2028 Blue Rock Dr Apt 204
Tampa, FL 33612-5144
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 |
|---|---|---|---|
| AL4485 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512691200000",
"number": "1871008169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2028 BLUE ROCK DR APT 204",
"city": "TAMPA",
"state": "FL",
"postal_code": "336125144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4202 E FOWLER AVE STOP ATH100",
"city": "TAMPA",
"state": "FL",
"postal_code": "336208455",
"telephone_number": "813-974-0661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "ANGEL",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-12-08",
"last_updated": "2017-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL4485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.