Provider Demographics
NPI:1629404330
Name:EUBANKS, TYLER STEVEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:STEVEN
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 PURPLEHORSE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3750
Mailing Address - Country:US
Mailing Address - Phone:919-412-8284
Mailing Address - Fax:
Practice Address - Street 1:4909 GREEN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3418
Practice Address - Country:US
Practice Address - Phone:919-790-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist