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General NPI Number Information
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NPI Number | 1144945114
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Entity Type | Individual
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Provider Name | TYLER DORSEY PTA, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 1611 QUARRIER ST APT A
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City | CHARLESTON
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State | WV
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Zip | 25311-2135
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Country | US
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Telephone | 304-667-0715
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Fax |
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Provider Business Mailing Address
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Address Line | 181 HEATHERTON DR
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City | LEWISBURG
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State | WV
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Zip | 24901-9623
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Country | US
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Telephone |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 002419
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 002419
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License Number State | WV
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