Healthcare Provider Details

I. General information

NPI: 1891504254
Provider Name (Legal Business Name): TYLER AUSTIN ZITKA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51600 HUNTINGTON RD STE 103
LA PINE OR
97739-8887
US

IV. Provider business mailing address

954 SW EMKAY DR APT 445
BEND OR
97702-0809
US

V. Phone/Fax

Practice location:
  • Phone: 541-536-7443
  • Fax:
Mailing address:
  • Phone: 623-271-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65551
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: