Provider Demographics
NPI:1174315162
Name:SMITH, TYLER B
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 W GUADALUPE RD STE 19
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7245
Mailing Address - Country:US
Mailing Address - Phone:210-412-3439
Mailing Address - Fax:
Practice Address - Street 1:2655 W GUADALUPE RD STE 19
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7245
Practice Address - Country:US
Practice Address - Phone:210-412-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No171400000XOther Service ProvidersHealth & Wellness Coach
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist