| NPI | 1306284062 |
|---|---|
| Former Name | TYLER JUSTIN SERVICE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8515460-2401) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2024-06-04 |