Provider Demographics
NPI:1902353709
Name:COUNTESS, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:COUNTESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6168 PUTTER DR
Mailing Address - Street 2:
Mailing Address - City:WESCOSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9608
Mailing Address - Country:US
Mailing Address - Phone:610-349-3157
Mailing Address - Fax:
Practice Address - Street 1:6168 PUTTER DR
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9608
Practice Address - Country:US
Practice Address - Phone:610-349-3157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer