Provider Demographics
NPI:1760612394
Name:TYLER, PATRICIA E (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:TYLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KILBURN ST
Mailing Address - Street 2:STE 120
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4720
Mailing Address - Country:US
Mailing Address - Phone:802-864-9642
Mailing Address - Fax:802-864-9643
Practice Address - Street 1:20 KILBURN ST
Practice Address - Street 2:STE 120
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4720
Practice Address - Country:US
Practice Address - Phone:802-864-9642
Practice Address - Fax:802-864-9643
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04000503782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic