Healthcare Provider Details

I. General information

NPI: 1861249666
Provider Name (Legal Business Name): TYLER NAVARRO PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 DANBURY RD
WILTON CT
06897-2548
US

IV. Provider business mailing address

137 MATTHEW DR
STRATFORD CT
06614-3346
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-2355
  • Fax:
Mailing address:
  • Phone: 203-767-3321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number012365
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: