Provider Demographics
NPI:1285708537
Name:PRO SPORTS PHYSICAL THERAPY OF WESTCHESTER, PC
Entity type:Organization
Organization Name:PRO SPORTS PHYSICAL THERAPY OF WESTCHESTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-723-6987
Mailing Address - Street 1:2 OVERHILL RD STE 315
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5316
Mailing Address - Country:US
Mailing Address - Phone:914-723-6987
Mailing Address - Fax:914-723-7546
Practice Address - Street 1:2 OVERHILL RD STE 315
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5316
Practice Address - Country:US
Practice Address - Phone:914-723-6987
Practice Address - Fax:914-723-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013634-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQG5881Medicare ID - Type Unspecified