Provider Demographics
NPI: | 1508318460 |
---|---|
Name: | TYLER INTEGRATIVE HEALTH AND WELLNESS, LLC |
Entity Type: | Organization |
Organization Name: | TYLER INTEGRATIVE HEALTH AND WELLNESS, LLC |
Other - Org Name: | INFINITY HEALTH SOLUTIONS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINIC DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DUNN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 903-483-1090 |
Mailing Address - Street 1: | 7062 HIGHLANDS LN |
Mailing Address - Street 2: | |
Mailing Address - City: | TYLER |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75703 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 903-483-1090 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7062 HIGHLANDS LN |
Practice Address - Street 2: | |
Practice Address - City: | TYLER |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75703 |
Practice Address - Country: | US |
Practice Address - Phone: | 903-483-1090 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-26 |
Last Update Date: | 2016-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty |