| Doctor Name: | TYLER NIEMACK |
| NPI Number: | 1700289055 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | PT60492910 |
| Business Practice Address: | 451 Sw Sedgwick Rd Ste. 310 Port Orchard, WA - 983676447 |
| Business Phone Number: | 3608748009 |
| Business Fax Number: | 3608748010 |
| Mailing Address: | 4040 Orchard St W, Ste. 100 FIRCREST |
| State: | WA |
| Postal Code: | 984666606 |
| Phone Number: | 2535641560 |
| Fax Number: | 2535644449 |
| NPI Enumeration Date: | 10/01/2014 |
| NPI Last Update Date: | 11/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT60492910 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |