Healthcare Provider Details

I. General information

NPI: 1376193573
Provider Name (Legal Business Name): TYLER YEAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3642 I ST SE APT B
AUBURN WA
98002-8082
US

IV. Provider business mailing address

3642 I ST SE APT B
AUBURN WA
98002-8082
US

V. Phone/Fax

Practice location:
  • Phone: 253-234-4876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160485069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: