Individual provider Active NPI

Tyler Reid Lacy, PT

  • Physical Therapist
  • Kalispell, MT
National Provider Identifier
1912536574
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
19144 Issued in MT
Practice address
100 Westview Park PL
Kalispell, MT 59901-3074
Phone
(406) 393-2473
Fax
(406) 393-2475
NPI assigned
Apr 6, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 19144 MT Primary

Addresses

Primary practice location

100 Westview Park PL
Kalispell, MT 59901-3074

Mailing address

100 Westview Park PL
Kalispell, MT 59901-3074
Phone (406) 393-2473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200504002925 MT Practitioner - Physical Therapist in Private Practice 8224469408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Precision Physical Therapy and Sports Rehab PCGroup PAC ID 0143461004, 7 clinicians

Practice addresses (Care Compare)

100 Westview Park PL
Kalispell, MT 59901-3074
Phone (406) 393-2474

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19144MTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Clinic PLLC CurrentSince Apr 2, 2020 Accepting new patients
Precision Physical Therapy & Sports Rehab PC CurrentSince Apr 2, 2020 Accepting new patients

Locations

100 Westview Park Pl
Kalispell, MT 59901
Phone (406) 393-2472

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1912536574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WESTVIEW PARK PL",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013074",
            "telephone_number": "406-393-2473",
            "fax_number": "406-393-2475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WESTVIEW PARK PL",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013074",
            "telephone_number": "406-393-2473",
            "fax_number": "406-393-2475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACY",
        "first_name": "TYLER",
        "middle_name": "REID",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "19144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.