Provider Demographics
NPI:1639519952
Name:SMITH, TYLER BROWN (PT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:BROWN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 OAK DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2883
Mailing Address - Country:US
Mailing Address - Phone:541-344-1771
Mailing Address - Fax:
Practice Address - Street 1:2360 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1861
Practice Address - Country:US
Practice Address - Phone:541-687-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04277225100000X
GA004856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist