Provider Demographics
NPI:1316438823
Name:TYNER, RACHEL MOORE (PT, DPT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MOORE
Last Name:TYNER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHRYN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1020 CENTRAL PKWY S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:210-798-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13048932251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics