Provider Demographics
NPI:1699523498
Name:BETTERIDGE, TYLER JEFFREY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JEFFREY
Last Name:BETTERIDGE
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 1:124 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-1212
Mailing Address - Country:US
Mailing Address - Phone:267-222-0398
Mailing Address - Fax:
Practice Address - Street 1:20501 SENECA MEADOWS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7017
Practice Address - Country:US
Practice Address - Phone:301-798-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist