Doctor Name: | TYLER DEAN SMITH |
NPI Number: | 1548495310 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 8542 |
Business Practice Address: | 2000 W Wickenburg Way Ste 200 Wickenburg, AZ - 853901074 |
Business Phone Number: | 9286680108 |
Business Fax Number: | 9286680110 |
Mailing Address: | 2000 W Wickenburg Way Ste 200, WICKENBURG |
State: | AZ |
Postal Code: | 853901074 |
Phone Number: | 9286680108 |
Fax Number: | 9286680110 |
NPI Enumeration Date: | 05/22/2009 |
NPI Last Update Date: | 10/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 8542 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |