Provider Demographics
NPI:1295275469
Name:MORRIS, TYLER (PTA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MIRROR LAKE BLVD
Mailing Address - Street 2:SUITE S
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2124
Mailing Address - Country:US
Mailing Address - Phone:770-456-7877
Mailing Address - Fax:770-456-7880
Practice Address - Street 1:2000 MIRROR LAKE BLVD
Practice Address - Street 2:SUITE S
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2124
Practice Address - Country:US
Practice Address - Phone:770-456-7877
Practice Address - Fax:770-456-7880
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003784225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant