Healthcare Provider Details

I. General information

NPI: 1720914559
Provider Name (Legal Business Name): TYLER KIRTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W ELLIOT RD STE 104-105
TEMPE AZ
85284-1373
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 480-756-8617
  • Fax: 480-820-9909
Mailing address:
  • Phone: 726-202-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034811
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: