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General NPI Number Information
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NPI Number | 1518418466
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Entity Type | Individual
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Provider Name | TYLER DUVAL
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Gender | Male
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Dates
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Enumeration Date | 10/16/2016
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Last Update Date | 10/16/2016
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Provider Practice Location Address
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Address Line | 239 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-7504
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Country | US
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Telephone | 603-224-6561
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Fax |
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Provider Business Mailing Address
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Address Line | 352A BEACON HILL RD
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City | PEMBROKE
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State | NH
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Zip | 03275-3302
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Country | US
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Telephone | 603-340-4723
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1252
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License Number State | NH
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