Healthcare Provider Details

I. General information

NPI: 1245117738
Provider Name (Legal Business Name): TYLER HOLYOAK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10903 W MCDOWELL RD
AVONDALE AZ
85392-5240
US

IV. Provider business mailing address

14 W PALMCROFT DR
TEMPE AZ
85282-2118
US

V. Phone/Fax

Practice location:
  • Phone: 623-404-4417
  • Fax:
Mailing address:
  • Phone: 928-719-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034295
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: