Healthcare Provider Details

I. General information

NPI: 1952145013
Provider Name (Legal Business Name): TYLER LANTZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7273 S SIWELL RD
BYRAM MS
39272-9767
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 315
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 601-372-8223
  • Fax: 601-372-8125
Mailing address:
  • Phone: 877-348-1281
  • Fax: 901-227-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7754
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: