Provider Demographics
NPI:1891504254
Name:ZITKA, TYLER AUSTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:AUSTIN
Last Name:ZITKA
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 1:954 SW EMKAY DR APT 445
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-0809
Mailing Address - Country:US
Mailing Address - Phone:623-271-2907
Mailing Address - Fax:
Practice Address - Street 1:51600 HUNTINGTON RD STE 103
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-8887
Practice Address - Country:US
Practice Address - Phone:541-536-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist