MEDICARE: TYR I

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1871458992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYR I

Provider Business Mailing Address
First Line	:	76 PLUM TREE DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2705
Country	:	US
Telephone Number	:	636-734-6852
Fax Number	:	636-734-6852

Provider Business Practice Location Address
First Line	:	76 PLUM TREE DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-2705
Country	:	US
Telephone Number	:	636-734-6852
Fax Number	:	636-734-6852

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHAD CROSS
Credential	:	CERTIFIED PT
Telephone Number	:	636-734-6852

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	12/20/2025

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