Provider Demographics
NPI:1093232969
Name:PHILLIPS, TYLER EVAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:EVAN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LODER ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1957
Mailing Address - Country:US
Mailing Address - Phone:607-324-9344
Mailing Address - Fax:607-324-9345
Practice Address - Street 1:100 LODER ST STE 105
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1957
Practice Address - Country:US
Practice Address - Phone:607-324-9344
Practice Address - Fax:607-324-9345
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist