Healthcare Provider Details

I. General information

NPI: 1639016579
Provider Name (Legal Business Name): TYLER STEWART PTA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 MARKET ST
DENTON MD
21629-3476
US

IV. Provider business mailing address

1131 MARKET ST
DENTON MD
21629-3476
US

V. Phone/Fax

Practice location:
  • Phone: 443-745-4932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6079
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: