Healthcare Provider Details

I. General information

NPI: 1437501822
Provider Name (Legal Business Name): TYLER ROBERTS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 05/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 MATHIAS PKWY
GARDNERVILLE NV
89410
US

IV. Provider business mailing address

5747 SE PAULEN RD
BERRYTON KS
66409
US

V. Phone/Fax

Practice location:
  • Phone: 785-250-0319
  • Fax:
Mailing address:
  • Phone: 785-250-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-05339
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: