Provider Demographics
NPI:1598249252
Name:KENTON, TYLER JOSEPH (DPT)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOSEPH
Last Name:KENTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 N 3RD ST APT 309
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3980
Mailing Address - Country:US
Mailing Address - Phone:302-233-1210
Mailing Address - Fax:332-777-1315
Practice Address - Street 1:666 BROADWAY LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2317
Practice Address - Country:US
Practice Address - Phone:302-233-1210
Practice Address - Fax:332-777-1315
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0383702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic