Provider Demographics
NPI:1982094892
Name:WHITFORD, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:WHITFORD
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 1:725 N 8TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-2052
Mailing Address - Country:US
Mailing Address - Phone:903-445-1093
Mailing Address - Fax:
Practice Address - Street 1:725 N 8TH ST
Practice Address - Street 2:APT 3
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-2052
Practice Address - Country:US
Practice Address - Phone:903-445-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer