MEDICARE: TYLER JOHN FERRELL PT, DPT

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	12553	TN
2	225100000X	Physical Therapist	11-06378	KS
3	225100000X	Physical Therapist	63144	OR
4	225100000X	Physical Therapist	008274	KY
5	225100000X	Physical Therapist	13206	AZ
6	225100000X	Physical Therapist	PT013939	GA
7	225100000X	Physical Therapist	2025007113	MO

General Provider Information

NPI Number	:	1285153924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JOHN FERRELL PT, DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3726 S KINGSHIGHWAY BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1800
Country	:	US
Telephone Number	:	314-351-7172
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	04/08/2026

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