Healthcare Provider Details

I. General information

NPI: 1033237953
Provider Name (Legal Business Name): COLLEEN CATHERINE TYE L.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 EBER RD
HOLLAND OH
43528-9616
US

IV. Provider business mailing address

449 CANAL CT
WATERVILLE OH
43566-1349
US

V. Phone/Fax

Practice location:
  • Phone: 419-866-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3546
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: