MEDICARE: MRS. ERICA RENEE TYLER 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	1191089	TX

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	:	1689807083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERICA RENEE TYLER PT, DPT

Provider Business Mailing Address
First Line	:	1001 N BEDELL AVE
Second Line	:	APT 3
City	:	DEL RIO
State	:	TX
Zip	:	78840-4166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 N BEDELL AVE
Second Line	:
City	:	DEL RIO
State	:	TX
Zip	:	78840-7818
Country	:	US
Telephone Number	:	830-774-1556
Fax Number	:	830-774-6150

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

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	07/13/2015

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