Provider Demographics
NPI:1518698745
Name:HENRIOD, TYRELL JAY (DPT)
Entity Type:Individual
Prefix:
First Name:TYRELL
Middle Name:JAY
Last Name:HENRIOD
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 1:7362 MCLAUGHLIN RD
Mailing Address - Street 2:
Mailing Address - City:FALCON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4713
Mailing Address - Country:US
Mailing Address - Phone:719-358-3866
Mailing Address - Fax:719-559-1800
Practice Address - Street 1:7362 MCLAUGHLIN RD
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4713
Practice Address - Country:US
Practice Address - Phone:193-583-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist