Provider Demographics
NPI:1336696301
Name:WYNN, TYLER MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MATTHEW
Last Name:WYNN
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 1:4440 GLEN ESTE WITHAMSVILLE RD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1318
Mailing Address - Country:US
Mailing Address - Phone:513-753-2133
Mailing Address - Fax:513-753-1804
Practice Address - Street 1:151 W GALBRAITH RD STE N2045
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1015
Practice Address - Country:US
Practice Address - Phone:513-418-2735
Practice Address - Fax:513-418-2775
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist