Provider Demographics
NPI:1619449428
Name:KINCH, TYLER (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:KINCH
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 EASTOVER RIDGE DR APT 1118
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1497
Mailing Address - Country:US
Mailing Address - Phone:586-453-5279
Mailing Address - Fax:
Practice Address - Street 1:3719 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8044
Practice Address - Country:US
Practice Address - Phone:704-830-2136
Practice Address - Fax:704-830-2138
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018694225100000X
SC.9139225100000X
NC18340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist