Healthcare Provider Details

I. General information

NPI: 1649714940
Provider Name (Legal Business Name): TYLER UBBEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 POWELL ST
FRUITA CO
81521-4108
US

IV. Provider business mailing address

1472 POWELL ST
FRUITA CO
81521-4108
US

V. Phone/Fax

Practice location:
  • Phone: 303-912-6017
  • Fax:
Mailing address:
  • Phone: 303-912-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0021320
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: