Provider Demographics
NPI:1245915883
Name:GAMBLE, TYLER JOSEPH (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:GAMBLE
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 1:6501 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1261
Mailing Address - Country:US
Mailing Address - Phone:317-670-3760
Mailing Address - Fax:
Practice Address - Street 1:4940 W 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1408
Practice Address - Country:US
Practice Address - Phone:317-297-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014281A146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant