MEDICARE: DR. TYLER PORTER PT, DPT, MED

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	CP038518T	CO
2	225100000X	Physical Therapist	CP054917T	NC
3	225100000X	Physical Therapist	2305216214	VA
4	225100000X	Physical Therapist	1400697	TX

General Provider Information

NPI Number	:	1437925336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER PORTER PT, DPT, MED

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 W HIGHWAY 74
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-8434
Country	:	US
Telephone Number	:	704-234-7461
Fax Number	:

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

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	06/02/2026

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