Provider Demographics
NPI:1851827570
Name:TYLER, EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TYLER
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 1:46-036 KAM HWY UNIT 5124
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-7711
Mailing Address - Country:US
Mailing Address - Phone:808-233-9219
Mailing Address - Fax:
Practice Address - Street 1:47-388 HUI IWA ST
Practice Address - Street 2:STE 21B
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-4416
Practice Address - Country:US
Practice Address - Phone:808-233-9219
Practice Address - Fax:808-444-3744
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI815293Medicaid