MEDICARE: MR. TYLER ARCEMENT PTA

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	2168684	TX

General Provider Information

NPI Number	:	1982348223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TYLER ARCEMENT PTA

Provider Business Mailing Address
First Line	:	1525 GRAND AVENUE PKWY APT 14207
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-4810
Country	:	US
Telephone Number	:	407-620-2568
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 OAKMONT TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-2841
Country	:	US
Telephone Number	:	817-292-2006
Fax Number	:

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

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	04/23/2022

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