Provider Demographics
NPI:1639828767
Name:BRICE, TIYLER LISA
Entity Type:Individual
Prefix:
First Name:TIYLER
Middle Name:LISA
Last Name:BRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N CENTRAL EXPY UNIT 524
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-0027
Mailing Address - Country:US
Mailing Address - Phone:214-228-2929
Mailing Address - Fax:
Practice Address - Street 1:1308 ORCHID DR APT A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-1159
Practice Address - Country:US
Practice Address - Phone:214-228-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120993225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000-00-0000OtherUNITED HEALTHCARE