Healthcare Provider Details

I. General information

NPI: 1851753685
Provider Name (Legal Business Name): TYLER BROOKS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 27TH ST E
BRADENTON FL
34208-7831
US

IV. Provider business mailing address

304 E CHESTNUT ST
JONESTOWN PA
17038-8960
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-3031
  • Fax:
Mailing address:
  • Phone: 717-865-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberRTO000265
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: