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NPI Code Detail

MEDICARE: MR. STEVEN DARRELL TYNDALL LPTA

MEDICARE: MR. STEVEN DARRELL TYNDALL LPTA
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
1313M00000XNursing Facility/Intermediate Care Facility1753NC

General Provider Information

NPI Number : 1194922807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEVEN DARRELL TYNDALL LPTA
Provider Business Mailing Address
First Line : 1409 LONG ST
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-9621
Country : US
Telephone Number : 704-438-6077
Fax Number :
Provider Business Practice Location Address
First Line : 7820 BALLANTYNE COMMONS PKWY STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-2889
Country : US
Telephone Number : 800-472-7117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 07/08/2007

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