Provider Demographics
NPI:1992382154
Name:BYMAN, TISHA
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:BYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SOUTHPOINT DR N STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0939
Mailing Address - Country:US
Mailing Address - Phone:904-470-6900
Mailing Address - Fax:904-470-6990
Practice Address - Street 1:6900 SOUTHPOINT DR N STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0939
Practice Address - Country:US
Practice Address - Phone:904-470-6900
Practice Address - Fax:904-470-6990
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter