Provider Demographics
NPI:1760168769
Name:LUND, TYLER (PT, DPT, CWS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:LUND
Suffix:
Gender:M
Credentials:PT, DPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 MIDNIGHT RIDE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1966
Mailing Address - Country:US
Mailing Address - Phone:801-505-3886
Mailing Address - Fax:
Practice Address - Street 1:7921 MIDNIGHT RIDE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-1966
Practice Address - Country:US
Practice Address - Phone:801-505-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist