Basic Information
| Provider Information | |||||||||
| NPI: | 1225683964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHAEL | ||||||||
| FirstName: | TYLER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7541 BOND ST | ||||||||
| Address2: | |||||||||
| City: | SAINT LEONARD | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206852949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436246095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2987 PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | DUNKIRK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207542735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439646348 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 27617 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.