MEDICARE: TYLER MICHAEL MICHOT PT, DPT

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	225100000X	Physical Therapist	1374092	TX

General Provider Information

NPI Number	:	1679391916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER MICHAEL MICHOT PT, DPT

Provider Business Mailing Address
First Line	:	8628 ANGEL GARDENS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3144
Country	:	US
Telephone Number	:	318-452-4514
Fax Number	:

Provider Business Practice Location Address
First Line	:	8628 ANGEL GARDENS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3144
Country	:	US
Telephone Number	:	318-452-4514
Fax Number	:

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	12/16/2025

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