Provider Demographics
NPI:1336944289
Name:OSTROWSKI, TYLER JOHN (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:OSTROWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 CHARMANT DR UNIT 1002
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4731
Mailing Address - Country:US
Mailing Address - Phone:856-649-2914
Mailing Address - Fax:
Practice Address - Street 1:8290 VICKERS ST STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2116
Practice Address - Country:US
Practice Address - Phone:619-510-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3069842081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine