Provider Demographics
NPI:1104439157
Name:BACHTEL, TYLER YUKIO
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:YUKIO
Last Name:BACHTEL
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 1:1546 GATEHOUSE CIR S APT 202
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2997
Mailing Address - Country:US
Mailing Address - Phone:661-805-5566
Mailing Address - Fax:
Practice Address - Street 1:2955 PROFESSIONAL PL STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8140
Practice Address - Country:US
Practice Address - Phone:719-227-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant