Provider Demographics
NPI:1295568129
Name:TODD, TYLER (PT, DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:TODD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-0024
Mailing Address - Country:US
Mailing Address - Phone:931-436-7992
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 24
Practice Address - Street 2:
Practice Address - City:HAWKINS
Practice Address - State:TX
Practice Address - Zip Code:75765
Practice Address - Country:US
Practice Address - Phone:931-436-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12355225100000X
NHCP033201T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist