Healthcare Provider Details

I. General information

NPI: 1912511676
Provider Name (Legal Business Name): TYLER SPENCER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LAUREL ST STE A
DES MOINES IA
50314-3045
US

IV. Provider business mailing address

450 LAUREL ST STE A
DES MOINES IA
50314-3045
US

V. Phone/Fax

Practice location:
  • Phone: 515-247-8400
  • Fax: 515-248-8888
Mailing address:
  • Phone: 515-247-8400
  • Fax: 515-248-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number102066
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: