Provider Demographics
NPI:1669077053
Name:SCHORTGEN, TYLER JOHN (LMT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:SCHORTGEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24590 E APPLEWOOD CIR UNIT 1023
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3919
Mailing Address - Country:US
Mailing Address - Phone:419-615-8557
Mailing Address - Fax:
Practice Address - Street 1:24590 E APPLEWOOD CIR UNIT 1023
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-3919
Practice Address - Country:US
Practice Address - Phone:419-615-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist