MEDICARE: TYLER WILLIAM BENZ

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	225200000X	Physical Therapy Assistant	2044634	TX

General Provider Information

NPI Number	:	1871722785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER WILLIAM BENZ

Provider Business Mailing Address
First Line	:	12941 NORTH FWY
Second Line	:	SUITE 401
City	:	HOUSTON
State	:	TX
Zip	:	77060-1240
Country	:	US
Telephone Number	:	832-253-1188
Fax Number	:	832-253-1181

Provider Business Practice Location Address
First Line	:	12941 NORTH FWY
Second Line	:	SUITE 401
City	:	HOUSTON
State	:	TX
Zip	:	77060-1240
Country	:	US
Telephone Number	:	832-253-1188
Fax Number	:	832-253-1181

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

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	04/17/2014

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