MEDICARE: EMPOWERED CARE PHYSICAL THERAPY AND WOUND CARE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1093491094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED CARE PHYSICAL THERAPY AND WOUND CARE PLLC

Provider Business Mailing Address
First Line	:	7921 MIDNIGHT RIDE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1966
Country	:	US
Telephone Number	:	801-505-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	7921 MIDNIGHT RIDE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1966
Country	:	US
Telephone Number	:	801-505-3886
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	DR. TYLER LUND
Credential	:	PT, DPT, CWS
Telephone Number	:	801-505-3886

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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