Basic Information
| Provider Information | |||||||||
| NPI: | 1952672750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLOWERS | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84 HIGHLAND AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787410880 | ||||||||
| FaxNumber: | 9787405595 | ||||||||
| Practice Location | |||||||||
| Address1: | 84 HIGHLAND AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787410880 | ||||||||
| FaxNumber: | 9787405595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2012 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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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 | 225200000X | 8294 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.