Provider Demographics
NPI:1386153310
Name:GREGORY, TYLER JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOSEPH
Last Name:GREGORY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3251
Mailing Address - Country:US
Mailing Address - Phone:978-855-5051
Mailing Address - Fax:
Practice Address - Street 1:7373 FRANCE AVE S STE 204
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4538
Practice Address - Country:US
Practice Address - Phone:952-428-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13947-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty