Provider Demographics
NPI:1053050781
Name:REED, TYLER TYMEL (PTA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:TYMEL
Last Name:REED
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 WESTGATE LN # 3-281
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1758
Mailing Address - Country:US
Mailing Address - Phone:662-501-1936
Mailing Address - Fax:
Practice Address - Street 1:3720 WESTGATE LN # 3-281
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-1758
Practice Address - Country:US
Practice Address - Phone:662-501-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA6792225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant