Provider Demographics
NPI:1851944334
Name:GREMBAN, TYLER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:GREMBAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W HORIZON RIDGE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2896
Mailing Address - Country:US
Mailing Address - Phone:702-896-0383
Mailing Address - Fax:702-889-0383
Practice Address - Street 1:2411 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5780
Practice Address - Country:US
Practice Address - Phone:702-458-1300
Practice Address - Fax:702-564-4838
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist