Provider Demographics
NPI:1861848244
Name:GOLDEN, TYLER JOHN
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 CHESTNUT RIDGE DR APT C
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3472
Mailing Address - Country:US
Mailing Address - Phone:717-877-2666
Mailing Address - Fax:
Practice Address - Street 1:4165 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3576
Practice Address - Country:US
Practice Address - Phone:540-437-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer