Healthcare Provider Details

I. General information

NPI: 1144512989
Provider Name (Legal Business Name): TYLER GUYMON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 N 113TH AVE # 6
AVONDALE AZ
85392-3938
US

IV. Provider business mailing address

14287 N 87TH ST STE 220
SCOTTSDALE AZ
85260-3698
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-7748
  • Fax:
Mailing address:
  • Phone: 480-937-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9305
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: