Provider Demographics
NPI:1710312657
Name:FOX, TYLER J (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:FOX
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1061
Mailing Address - Country:US
Mailing Address - Phone:816-665-9467
Mailing Address - Fax:
Practice Address - Street 1:4233 GRASSMERE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1040
Practice Address - Country:US
Practice Address - Phone:816-665-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT53122255A2300X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No171W00000XOther Service ProvidersContractor