Healthcare Provider Details

I. General information

NPI: 1063575090
Provider Name (Legal Business Name): TYLER F ESHLEMAN MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N FIRST ST SUITE 103
BURBANK CA
91502-1845
US

IV. Provider business mailing address

100 N FIRST ST SUITE 103
BURBANK CA
91502-1845
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-7100
  • Fax: 818-846-7101
Mailing address:
  • Phone: 818-846-7100
  • Fax: 818-846-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0250941
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: