Healthcare Provider Details

I. General information

NPI: 1801722897
Provider Name (Legal Business Name): TYLER BERIAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ROUTE 34 STE 108
COLTS NECK NJ
07722-2523
US

IV. Provider business mailing address

415 ROUTE 34 STE 108
COLTS NECK NJ
07722-2523
US

V. Phone/Fax

Practice location:
  • Phone: 732-858-1335
  • Fax:
Mailing address:
  • Phone: 732-858-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA0245900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: