Provider Demographics
NPI:1871012534
Name:HOLLENBECK, TYLER JUSTIN
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JUSTIN
Last Name:HOLLENBECK
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 1:1131 JACKSON AVE UNIT 3301
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-8412
Mailing Address - Country:US
Mailing Address - Phone:901-605-9784
Mailing Address - Fax:
Practice Address - Street 1:1131 JACKSON AVE
Practice Address - Street 2:UNIT 3301
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:901-605-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer