Provider Demographics
NPI:1659994887
Name:STEWART, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 35TH LN
Mailing Address - Street 2:STE 100
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6522
Mailing Address - Country:US
Mailing Address - Phone:772-257-3621
Mailing Address - Fax:772-569-4616
Practice Address - Street 1:8861 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3209
Practice Address - Country:US
Practice Address - Phone:214-618-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic