Healthcare Provider Details

I. General information

NPI: 1659240703
Provider Name (Legal Business Name): TYLER EDMUND HARGIS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3044 WADE HAMPTON BLVD
TAYLORS SC
29687-2716
US

IV. Provider business mailing address

1007 GROVE RD STE C
GREENVILLE SC
29605-4630
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-5128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number13122
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: