Provider Demographics
NPI:1265110027
Name:FIDLER, TYLER SCOTT
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:SCOTT
Last Name:FIDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2104
Mailing Address - Country:US
Mailing Address - Phone:661-342-4223
Mailing Address - Fax:
Practice Address - Street 1:16300 ROSCOE BLVD STE A1
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1246
Practice Address - Country:US
Practice Address - Phone:442-681-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy