MEDICARE: THE HEALTHY PLACE 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	363A00000X	Physician Assistant
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1659255859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HEALTHY PLACE PLLC

Provider Business Mailing Address
First Line	:	18017 W MONTEBELLO AVE
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-2573
Country	:	US
Telephone Number	:	586-612-0476
Fax Number	:	602-563-8218

Provider Business Practice Location Address
First Line	:	2942 N 24TH ST. STE 115
Second Line	:	PMB 818048
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	602-603-7375
Fax Number	:	602-563-8218

Authorized Official
Title or Position	:	CO-OWNER
Name	:	TYLER ANDERSON
Credential	:
Telephone Number	:	586-612-0476

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	01/28/2026

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