Provider Demographics
NPI:1881035954
Name:MURRY, TYLER MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MATTHEW
Last Name:MURRY
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 1:700 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3658
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:1726 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6022
Practice Address - Country:US
Practice Address - Phone:405-293-6138
Practice Address - Fax:405-293-6252
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200661410AMedicaid