Provider Demographics
NPI:1750923363
Name:TYLER WILLIAMS PHYSICAL THERAPY
Entity type:Organization
Organization Name:TYLER WILLIAMS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:WILLIAMS-ELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-921-3372
Mailing Address - Street 1:16556 SEVERN RD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1241
Mailing Address - Country:US
Mailing Address - Phone:208-921-3372
Mailing Address - Fax:
Practice Address - Street 1:16556 SEVERN RD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1241
Practice Address - Country:US
Practice Address - Phone:208-921-3372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty