Provider Demographics
NPI:1144905381
Name:HARRY, TYLER (PT, DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:HARRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 POWERS CENTER PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7100
Mailing Address - Country:US
Mailing Address - Phone:719-785-1696
Mailing Address - Fax:719-785-1699
Practice Address - Street 1:5570 POWERS CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7100
Practice Address - Country:US
Practice Address - Phone:719-785-1696
Practice Address - Fax:719-785-1699
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019187225100000X
COPTL.0019187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist