Provider Demographics
NPI:1770250755
Name:WINDER, TYSON (DPT)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:WINDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 S 180 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2231
Mailing Address - Country:US
Mailing Address - Phone:435-632-8134
Mailing Address - Fax:
Practice Address - Street 1:75 N 2260 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2034
Practice Address - Country:US
Practice Address - Phone:435-635-6480
Practice Address - Fax:435-635-6499
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11791935-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic