MEDICARE: MR. TYLER EMERSON POMEROY MSPT, OCS, FAAOMPT

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	PT 3112	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225016728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TYLER EMERSON POMEROY MSPT, OCS, FAAOMPT

Provider Business Mailing Address
First Line	:	1410 FRETZ DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5782
Country	:	US
Telephone Number	:	405-285-8477
Fax Number	:	405-285-8499

Provider Business Practice Location Address
First Line	:	1410 FRETZ DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5782
Country	:	US
Telephone Number	:	405-285-8477
Fax Number	:	405-285-8499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	05/20/2008

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