Healthcare Provider Details

I. General information

NPI: 1295456440
Provider Name (Legal Business Name): TYLER CORTRIGHT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OAK ST
HILLSDALE MI
49242-1361
US

IV. Provider business mailing address

10414 DENNINGS RD
JONESVILLE MI
49250-9364
US

V. Phone/Fax

Practice location:
  • Phone: 517-607-3193
  • Fax:
Mailing address:
  • Phone: 517-425-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2601000171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: