Provider Demographics
NPI:1568987246
Name:VANWINGERDEN, TYLER JAY (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAY
Last Name:VANWINGERDEN
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 1:2075 BARKLEY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6696
Mailing Address - Country:US
Mailing Address - Phone:360-734-7306
Mailing Address - Fax:
Practice Address - Street 1:2075 BARKLEY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6696
Practice Address - Country:US
Practice Address - Phone:360-734-7306
Practice Address - Fax:360-734-7306
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60769750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist