Healthcare Provider Details

I. General information

NPI: 1215853791
Provider Name (Legal Business Name): TYLER TOLEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CENTEROCK RD STE 3
WEST NYACK NY
10994-2214
US

IV. Provider business mailing address

2 LISA DR
HIGHLAND MILLS NY
10930-2155
US

V. Phone/Fax

Practice location:
  • Phone: 914-597-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054573
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: