Provider Demographics
NPI:1710290929
Name:GILSON, TYLER B (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:B
Last Name:GILSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:
Practice Address - City:MC ALISTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17049-8499
Practice Address - Country:US
Practice Address - Phone:717-436-3004
Practice Address - Fax:717-436-3006
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHYP2276225100000X
PADAPT002728225100000X
PAPT020656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025027750001Medicaid