Healthcare Provider Details

I. General information

NPI: 1851536569
Provider Name (Legal Business Name): TYLER STUART ROOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6696 WARREN DR
DENVER CO
80221
US

IV. Provider business mailing address

6696 WARREN DR
DENVER CO
80221-2662
US

V. Phone/Fax

Practice location:
  • Phone: 419-674-7116
  • Fax:
Mailing address:
  • Phone: 419-674-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: