MEDICARE: MR. ALAN D TYSON PT

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	2251X0800X	Orthopedic Physical Therapist	2487	NC
2	225100000X	Physical Therapist	10819	SC

General Provider Information

NPI Number	:	1548244908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN D TYSON PT

Provider Business Mailing Address
First Line	:	1429 BRYANT ST STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5201
Country	:	US
Telephone Number	:	704-919-0867
Fax Number	:	704-817-8579

Provider Business Practice Location Address
First Line	:	11415 GOLF LINKS DR STE 102
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8229
Country	:	US
Telephone Number	:	980-470-5551
Fax Number	:	980-470-5551

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	04/13/2026

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