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General NPI Number Information
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NPI Number | 1053050781
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Entity Type | Individual
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Provider Name | TYLER TYMEL REED PTA
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Gender | Male
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 3720 WESTGATE LN # 3-281
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City | ADDISON
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State | TX
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Zip | 75001-1758
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Country | US
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Telephone | 662-501-1936
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 WESTGATE LN # 3-281
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City | ADDISON
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State | TX
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Zip | 75001-1758
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Country | US
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Telephone | 662-501-1936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA6792
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License Number State | MS
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