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General NPI Number Information
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NPI Number | 1942168703
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Entity Type | Individual
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Provider Name | TYREASE ALEXANDER DUTTON-BICALHO
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Gender | Male
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 415 S 10TH ST
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City | ATCHISON
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State | KS
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Zip | 66002-2771
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Country | US
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Telephone | 913-370-9501
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7217
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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 | 2025045387
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 14-04388
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License Number State | KS
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