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NPI Code Detail

MEDICARE: TYLER SMITH

MEDICARE: TYLER SMITH
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 Therapist9832247-2401UT

General Provider Information

NPI Number : 1831845320
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER SMITH
Provider Business Mailing Address
First Line : 717 E ELGIN AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1601
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1212 E WILMINGTON AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-2851
Country : US
Telephone Number : 800-967-4667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2022
Last Update Date : 09/11/2023

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Directions to “ TYLER SMITH ” Practice Location

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