Provider Demographics
NPI:1922525369
Name:BALFOUR, TYLER SCOTT (DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:BALFOUR
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 1:4974 HAPPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1668
Mailing Address - Country:US
Mailing Address - Phone:817-253-6591
Mailing Address - Fax:
Practice Address - Street 1:1755 HIGHWAY 34 E STE 1300
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3186
Practice Address - Country:US
Practice Address - Phone:770-502-2175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-26
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist