Healthcare Provider Details

I. General information

NPI: 1558224907
Provider Name (Legal Business Name): TYLER GRUWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6788 S KINGS RANCH RD STE 4
GOLD CANYON AZ
85118-2928
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-1909
  • Fax: 480-982-3002
Mailing address:
  • Phone: 726-202-3039
  • Fax: 210-978-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: