Basic Information
Provider Information
NPI: 1750941480
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORMSBY
FirstName: TYLER
MiddleName: LAURENCE
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2900 SUNRIDGE HEIGHTS PKWY APT 218
Address2:  
City: HENDERSON
State: NV
PostalCode: 890524471
CountryCode: US
TelephoneNumber: 4357400191
FaxNumber:  
Practice Location
Address1: 10301 JEFFREYS ST
Address2:  
City: HENDERSON
State: NV
PostalCode: 890523922
CountryCode: US
TelephoneNumber: 7029399400
FaxNumber: 7029399746
Other Information
ProviderEnumerationDate: 06/14/2019
LastUpdateDate: 06/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X4040NVY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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