Provider Demographics
NPI:1891532362
Name:DITMAS PARK WELLNESS PT PLLC
Entity type:Organization
Organization Name:DITMAS PARK WELLNESS PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEG
Authorized Official - Middle Name:
Authorized Official - Last Name:TYGER TYNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:516-521-0347
Mailing Address - Street 1:10 SLOCUM PL APT 4E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4364
Mailing Address - Country:US
Mailing Address - Phone:516-521-0347
Mailing Address - Fax:
Practice Address - Street 1:1103 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5303
Practice Address - Country:US
Practice Address - Phone:516-521-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy