Healthcare Provider Details

I. General information

NPI: 1548960552
Provider Name (Legal Business Name): TYLER MOK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-9502
US

IV. Provider business mailing address

4040 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-9502
US

V. Phone/Fax

Practice location:
  • Phone: 407-573-3361
  • Fax: 407-395-8309
Mailing address:
  • Phone: 407-573-3361
  • Fax: 407-395-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050009
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: