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NPI Code Detail

MEDICARE: TYLER EDWARD UTTECH

MEDICARE: TYLER EDWARD UTTECH
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
1225100000XPhysical Therapist070.026885IL

General Provider Information

NPI Number : 1760106603
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER EDWARD UTTECH
Provider Business Mailing Address
First Line : 843 W CORNELIA AVE APT 3S
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1727
Country : US
Telephone Number : 262-914-9461
Fax Number :
Provider Business Practice Location Address
First Line : 2316 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7760
Country : US
Telephone Number : 312-739-3030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 10/03/2022

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Directions to “ TYLER EDWARD UTTECH ” Practice Location

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