Provider Demographics
NPI:1033481445
Name:SCIOLINO, TYLER ALEXANDER (LMT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:ALEXANDER
Last Name:SCIOLINO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:HUBER
Other - Last Name:SCIOLINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:4975 GOODRICH RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2403
Mailing Address - Country:US
Mailing Address - Phone:716-880-6291
Mailing Address - Fax:
Practice Address - Street 1:8560 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7460
Practice Address - Country:US
Practice Address - Phone:716-880-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025477225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist