Provider Demographics
NPI:1336682533
Name:TRUITT, TYLER (DPT, PT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:TRUITT
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 OVERTON RIDGE BLVD STE 228
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3281
Mailing Address - Country:US
Mailing Address - Phone:817-259-1255
Mailing Address - Fax:817-764-9008
Practice Address - Street 1:5500 OVERTON RIDGE BLVD STE 228
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3281
Practice Address - Country:US
Practice Address - Phone:817-259-1255
Practice Address - Fax:817-764-9008
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1283919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist