Healthcare Provider Details

I. General information

NPI: 1578791125
Provider Name (Legal Business Name): TYLER JAY SNOW D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-1000
US

IV. Provider business mailing address

9040 FITZSIMMONS DR
JOINT BASE LEWIS MCCHORD WA
98431-1000
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4890
  • Fax:
Mailing address:
  • Phone: 253-968-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60099102
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPU60091776
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPU60091776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: