Provider Demographics
NPI:1962142083
Name:TYLER, ELIZABETH HALSTEAD (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HALSTEAD
Last Name:TYLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3124 BLITHEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:757-814-5636
Mailing Address - Fax:
Practice Address - Street 1:9980 BROOK RD UNIT 16
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-6501
Practice Address - Country:US
Practice Address - Phone:919-258-2714
Practice Address - Fax:410-648-4878
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist