MEDICARE: ALLEN TYLER NANCE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	00004730	TN
2	225100000X	Physical Therapist	00004730	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124023197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN TYLER NANCE P.T.

Provider Business Mailing Address
First Line	:	PO BOX 200880
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-0880
Country	:	US
Telephone Number	:	678-837-7176
Fax Number	:	404-777-1311

Provider Business Practice Location Address
First Line	:	6510 HIGHWAY 90 STE D
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5015
Country	:	US
Telephone Number	:	228-875-7259
Fax Number	:	228-438-2038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/12/2025

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Directions to “ ALLEN TYLER NANCE P.T.” Practice Location

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