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NPI Code Detail

MEDICARE: TYLER EISENBACHER PT, DPT

MEDICARE: TYLER EISENBACHER 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
1225100000XPhysical TherapistPT34674FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982262069
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER EISENBACHER PT, DPT
Provider Business Mailing Address
First Line : 4539 S DALE MABRY HWY STE 110
Second Line :
City : TAMPA
State : FL
Zip : 33611-1404
Country : US
Telephone Number : 813-250-1208
Fax Number : 813-250-1209
Provider Business Practice Location Address
First Line : 4539 S DALE MABRY HWY STE 110
Second Line :
City : TAMPA
State : FL
Zip : 33611-1404
Country : US
Telephone Number : 813-250-1208
Fax Number : 813-250-1209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 06/03/2019

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