Healthcare Provider Details

I. General information

NPI: 1376476879
Provider Name (Legal Business Name): TYLER NORTON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S MAIN ST
MOULTRIE GA
31768-6925
US

IV. Provider business mailing address

785 LOVETT CIR
SPARKS GA
31647-6817
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-3420
  • Fax:
Mailing address:
  • Phone: 229-300-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018164
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: