Provider Demographics
NPI:1245468149
Name:TYLER, BRANDON SCOT (DPT)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:SCOT
Last Name:TYLER
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 1:101 GILL STREET
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701
Mailing Address - Country:US
Mailing Address - Phone:865-980-0030
Mailing Address - Fax:865-980-0031
Practice Address - Street 1:101 GILL STREET
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701
Practice Address - Country:US
Practice Address - Phone:865-980-0030
Practice Address - Fax:865-980-0031
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT8297225100000X
TNPT 0000008297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513908Medicaid
TN3370059Medicare PIN
TN1093848442Medicare UPIN
TN1513908Medicaid