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General NPI Number Information
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NPI Number | 1235087602
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Entity Type | Individual
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Provider Name | TYLER CANNELLA
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Gender | Male
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 25411 SEA BLUFFS DR
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City | DANA POINT
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State | CA
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Zip | 92629-2190
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Country | US
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Telephone | 949-541-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 COUNTY ROAD 782
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City | WOODLAND PARK
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State | CO
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Zip | 80863-9614
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Country | US
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Telephone | 719-290-5553
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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