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General NPI Number Information
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NPI Number | 1376900357
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Entity Type | Organization
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Legal Business Name | TYLER INTEGRATED PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 120 E SOUTH TOWN DR
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City | TYLER
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State | TX
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Zip | 75703-4747
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Country | US
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Telephone | 903-312-7969
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 ESE LOOP323 SUITE 450B
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City | TYLER
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State | TX
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Zip | 75701-9664
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Country | US
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Telephone | 903-312-7969
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. TAMARA RHYNE
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Credential | MPT
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Telephone | 903-312-7969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1112985
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License Number State | TX
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