Healthcare Provider Details

I. General information

NPI: 1932021581
Provider Name (Legal Business Name): TYLER MACK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY STE 410
NOVI MI
48374-1263
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY STE 410
NOVI MI
48374-1263
US

V. Phone/Fax

Practice location:
  • Phone: 248-468-4796
  • Fax: 248-468-4793
Mailing address:
  • Phone: 248-468-4796
  • Fax: 248-468-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304578
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: