Healthcare Provider Details

I. General information

NPI: 1407774870
Provider Name (Legal Business Name): BENJAMIN TYLER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W STE 102
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

23815 23RD AVE W
BOTHELL WA
98021-9207
US

V. Phone/Fax

Practice location:
  • Phone: 425-470-5556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70131920
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: