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General NPI Number Information
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NPI Number | 1790392058
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Entity Type | Individual
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Provider Name | TYLER JAMES THORNBURG PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3925 DOWNS DR
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City | CHANTILLY
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State | VA
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Zip | 20151-3308
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Country | US
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Telephone | 877-407-3422
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Fax | 877-407-4329
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28140
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT004346
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License Number State | WV
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