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General NPI Number Information
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NPI Number | 1871458992
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Entity Type | Organization
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Legal Business Name | TYR I
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Dates
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Enumeration Date | 12/20/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 76 PLUM TREE DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-2705
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Country | US
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Telephone | 636-734-6852
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Fax | 636-734-6852
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Provider Business Mailing Address
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Address Line | 76 PLUM TREE DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-2705
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Country | US
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Telephone | 636-734-6852
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Fax | 636-734-6852
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Authorized Official
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Title or Position | CEO
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Name | MR. CHAD CROSS
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Credential | CERTIFIED PT
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Telephone | 636-734-6852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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