Provider Demographics
NPI:1003460510
Name:VAN ACKER, TYLER (DPT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:VAN ACKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 LONG LAKE CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9640
Mailing Address - Country:US
Mailing Address - Phone:586-854-7348
Mailing Address - Fax:
Practice Address - Street 1:2160 APPIAN WAY STE 101
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2524
Practice Address - Country:US
Practice Address - Phone:510-724-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist