Provider Demographics
NPI:1285119388
Name:DENN-THIELE, TYLER JASON (DPT)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JASON
Last Name:DENN-THIELE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:812-590-8333
Practice Address - Street 1:33492 OAK GLEN RD STE H
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2096
Practice Address - Country:US
Practice Address - Phone:909-797-5155
Practice Address - Fax:909-797-2768
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK203036225100000X
TX1343072225100000X
CA305014225100000X
NYP13371225100000X
NY043888-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist