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General NPI Number Information
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NPI Number | 1427726744
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Entity Type | Individual
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Provider Name | TYLER JACKSON KOLZOW PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 7119 E BROADWAY BLVD
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City | TUCSON
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State | AZ
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Zip | 85710-1404
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Country | US
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Telephone | 520-881-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 2469 GREEN VALLEY CT
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City | AURORA
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State | IL
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Zip | 60503-5756
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Country | US
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Telephone | 630-864-7926
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | LPT-31924
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License Number State | AZ
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