Individual provider Active NPI

Tyler Nolan, DPT

  • Physical Therapist
  • Virginia Beach, VA
National Provider Identifier
1881045003
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305204042 Issued in VA
Practice address
928 Diamond Springs Rd Ste 103
Virginia Beach, VA 23455-6601
Phone
(757) 395-1975
Fax
(757) 425-7180
NPI assigned
Jun 29, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 27575 MD
Physical Therapist 225100000X PT 31499 FL
Physical Therapist 225100000X 2305204042 VA Primary

Addresses

Primary practice location

928 Diamond Springs Rd Ste 103
Virginia Beach, VA 23455-6601

Mailing address

928 Diamond Springs Rd Ste 103
Virginia Beach, VA 23455-6601
Phone (757) 395-1975

Other practice location 1

3901 University Blvd S
Jacksonville, FL 32216-4312
Phone (904) 345-7200

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

LicenseStateTypeSpecialty
PT 31499FLMDPhysical Therapist
2305204042VAMDPhysical Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1881045003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 DIAMOND SPRINGS RD STE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556601",
            "telephone_number": "757-395-1975",
            "fax_number": "757-425-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 DIAMOND SPRINGS RD STE 103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556601",
            "telephone_number": "757-395-1975",
            "fax_number": "757-425-7180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3901 University Blvd S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322164312",
            "country_code": "US",
            "telephone_number": "904-345-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-29",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "27575",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 31499",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305204042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.