Healthcare Provider Details

I. General information

NPI: 1982262069
Provider Name (Legal Business Name): TYLER EISENBACHER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 S DALE MABRY HWY STE 110
TAMPA FL
33611-1404
US

IV. Provider business mailing address

4539 S DALE MABRY HWY STE 110
TAMPA FL
33611-1404
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-1208
  • Fax: 813-250-1209
Mailing address:
  • Phone: 813-250-1208
  • Fax: 813-250-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: