Healthcare Provider Details

I. General information

NPI: 1063342632
Provider Name (Legal Business Name): JESSICA TYLER PT, DPT, CERT. DN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BEITNER

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 W HAPPY VALLEY PKWY STE 100B
PEORIA AZ
85383-4691
US

IV. Provider business mailing address

18396 W ROBIN LN
SURPRISE AZ
85387-1586
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32516
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: