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NPI Code Detail

MEDICARE: TYLER NOLAN DPT

MEDICARE: TYLER NOLAN 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
1225100000XPhysical Therapist27575MD
2225100000XPhysical TherapistPT 31499FL
3225100000XPhysical Therapist2305204042VA

General Provider Information

NPI Number : 1881045003
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER NOLAN DPT
Provider Business Mailing Address
First Line : 928 DIAMOND SPRINGS RD STE 103
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6601
Country : US
Telephone Number : 757-395-1975
Fax Number : 757-425-7180
Provider Business Practice Location Address
First Line : 928 DIAMOND SPRINGS RD STE 103
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6601
Country : US
Telephone Number : 757-395-1975
Fax Number : 757-425-7180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2016
Last Update Date : 12/18/2020

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Practice Location Address:
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Practice Fax: 757-425-7180

Directions to “ TYLER NOLAN DPT” Practice Location

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