Healthcare Provider Details

I. General information

NPI: 1679391916
Provider Name (Legal Business Name): TYLER MICHAEL MICHOT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8628 ANGEL GARDENS DR
FORT WORTH TX
76179-3144
US

IV. Provider business mailing address

8628 ANGEL GARDENS DR
FORT WORTH TX
76179-3144
US

V. Phone/Fax

Practice location:
  • Phone: 318-452-4514
  • Fax:
Mailing address:
  • Phone: 318-452-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1374092
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: