Provider Demographics
NPI:1770961690
Name:REINTHALER, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:REINTHALER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 ROUTE 130
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3520 ROUTE 130
Practice Address - Street 2:SUITE 1
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1438
Practice Address - Country:US
Practice Address - Phone:724-744-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine