Provider Demographics
NPI:1467988444
Name:STARKWEATHER, TYLER JOHN (DPT)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOHN
Last Name:STARKWEATHER
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 1:205 GRANDVIEW DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6948
Mailing Address - Country:US
Mailing Address - Phone:843-261-1000
Mailing Address - Fax:843-261-1002
Practice Address - Street 1:205 GRANDVIEW DR UNIT D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6948
Practice Address - Country:US
Practice Address - Phone:843-261-1000
Practice Address - Fax:843-261-1002
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist