Healthcare Provider Details

I. General information

NPI: 1992464796
Provider Name (Legal Business Name): TYLER STEELE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 GARDEN COTY
GARDEN CITY MI
48136-2319
US

IV. Provider business mailing address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-0065
  • Fax:
Mailing address:
  • Phone: 734-522-0065
  • Fax: 734-522-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501021538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: