Provider Demographics
NPI:1417395906
Name:CHARLTON, TYEE (PT)
Entity Type:Individual
Prefix:
First Name:TYEE
Middle Name:
Last Name:CHARLTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 S DURANGO DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8158
Mailing Address - Country:US
Mailing Address - Phone:702-898-7633
Mailing Address - Fax:702-898-6433
Practice Address - Street 1:4765 S DURANGO DR STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8158
Practice Address - Country:US
Practice Address - Phone:702-898-7633
Practice Address - Fax:702-898-6433
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2821225100000X
WAPT60698384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist