Provider Demographics
NPI:1780767178
Name:COMER, TYLER DOUGLAS (PT)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:DOUGLAS
Last Name:COMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1342 E ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3242
Mailing Address - Country:US
Mailing Address - Phone:602-300-7886
Mailing Address - Fax:602-944-2176
Practice Address - Street 1:717 W. DUNLAP AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:602-944-2146
Practice Address - Fax:602-944-2176
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112549Medicare PIN