Provider Demographics
NPI:1619988995
Name:TYLER, AMY M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:TYLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:248 TOM HILL SR BLVD
Mailing Address - Street 2:# 331
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1815
Mailing Address - Country:US
Mailing Address - Phone:478-471-1004
Mailing Address - Fax:478-471-1048
Practice Address - Street 1:3200 RIVERSIDE DR
Practice Address - Street 2:SUITE 300-A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2550
Practice Address - Country:US
Practice Address - Phone:478-471-1004
Practice Address - Fax:478-471-1048
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001627225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant