Provider Demographics
NPI:1558760447
Name:MILLER, TYLER GENE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:GENE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8907
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:3855 SHALLOWFORD RD
Practice Address - Street 2:STE 415
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4195
Practice Address - Country:US
Practice Address - Phone:678-352-0828
Practice Address - Fax:678-352-0829
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006812225100000X
TN10067225100000X
GAPT012763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist