Provider Demographics
NPI:1609500800
Name:WHILLOCK, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:WHILLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 FAIR CHASE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0647
Mailing Address - Country:US
Mailing Address - Phone:713-828-9763
Mailing Address - Fax:
Practice Address - Street 1:3000 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6121
Practice Address - Country:US
Practice Address - Phone:972-473-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist