Healthcare Provider Details

I. General information

NPI: 1306334271
Provider Name (Legal Business Name): TYLER GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEST DR
VISTA CA
92083-6115
US

IV. Provider business mailing address

843 4TH ST APT E
ENCINITAS CA
92024-3414
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-271-3183
Mailing address:
  • Phone: 760-525-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: