Provider Demographics
NPI:1164764734
Name:TYLER, AMBER THAIS (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:THAIS
Last Name:TYLER
Suffix:
Gender:F
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 1:196 W GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1828
Mailing Address - Country:US
Mailing Address - Phone:610-212-7753
Mailing Address - Fax:
Practice Address - Street 1:196 W GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1828
Practice Address - Country:US
Practice Address - Phone:610-212-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020325225100000X
NY036952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist