Healthcare Provider Details

I. General information

NPI: 1306687405
Provider Name (Legal Business Name): ANNA TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POLARIS PKWY
WESTERVILLE OH
43082-7989
US

IV. Provider business mailing address

1374 LINCOLN RD
COLUMBUS OH
43212-3208
US

V. Phone/Fax

Practice location:
  • Phone: 614-533-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT021049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: