Provider Demographics
NPI:1295194561
Name:ROSS, TYLER LANG (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LANG
Last Name:ROSS
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 1:10628 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8407
Mailing Address - Country:US
Mailing Address - Phone:704-667-1000
Mailing Address - Fax:
Practice Address - Street 1:1090 NE GATEWAY CT NE STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2424
Practice Address - Country:US
Practice Address - Phone:704-403-9239
Practice Address - Fax:704-403-9204
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist