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General NPI Number Information
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NPI Number | 1124023197
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Entity Type | Individual
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Provider Name | ALLEN TYLER NANCE P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 6510 HIGHWAY 90 STE D
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City | GAUTIER
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State | MS
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Zip | 39553-5015
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Country | US
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Telephone | 228-875-7259
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Fax | 228-438-2038
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Provider Business Mailing Address
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Address Line | PO BOX 200880
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City | DALLAS
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State | TX
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Zip | 75320-0880
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Country | US
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Telephone | 678-837-7176
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Fax | 404-777-1311
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 00004730
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 00004730
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License Number State | TN
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