Healthcare Provider Details

I. General information

NPI: 1336499839
Provider Name (Legal Business Name): TYLER J OPITZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 UNIVERSITY PKWY REHABILITATION
PENSACOLA FL
32514-5752
US

IV. Provider business mailing address

9400 UNIVERSITY PKWY REHABILITATION
PENSACOLA FL
32514-5752
US

V. Phone/Fax

Practice location:
  • Phone: 850-208-6120
  • Fax:
Mailing address:
  • Phone: 850-208-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39257
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT 27504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: