Provider Demographics
NPI:1700239894
Name:GAJDOS, TYLER JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSEPH
Last Name:GAJDOS
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 1:4398 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3638
Mailing Address - Country:US
Mailing Address - Phone:216-789-1441
Mailing Address - Fax:
Practice Address - Street 1:4398 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3638
Practice Address - Country:US
Practice Address - Phone:216-789-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016053314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility