Provider Demographics
NPI:1255848156
Name:SMITH, TYLER (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11618 US 70 BUSINESS HWY W
Mailing Address - Street 2:STE 106
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2276
Mailing Address - Country:US
Mailing Address - Phone:919-373-2000
Mailing Address - Fax:919-373-2200
Practice Address - Street 1:11618 US 70 BUSINESS HWY W
Practice Address - Street 2:STE 106
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2276
Practice Address - Country:US
Practice Address - Phone:919-373-2000
Practice Address - Fax:919-373-2200
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist