Provider Demographics
NPI:1427567577
Name:BOULTER, TYLER CRAIG (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CRAIG
Last Name:BOULTER
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 1:18 W SERGEANT COURT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5805
Mailing Address - Country:US
Mailing Address - Phone:801-766-0103
Mailing Address - Fax:801-766-0136
Practice Address - Street 1:18 W SERGEANT COURT DR STE 101
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5805
Practice Address - Country:US
Practice Address - Phone:801-766-0103
Practice Address - Fax:801-766-0136
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist