Provider Demographics
NPI:1922882117
Name:TYLER, MATTHEW GRAYSON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GRAYSON
Last Name:TYLER
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 1:6147 JIM CROW RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2507
Mailing Address - Country:US
Mailing Address - Phone:678-551-3264
Mailing Address - Fax:
Practice Address - Street 1:130 AMICKS FERRY RD STE G
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9400
Practice Address - Country:US
Practice Address - Phone:803-932-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist