Provider Demographics
NPI:1992918452
Name:BROWN, TYLER RICHMOND (PT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:RICHMOND
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1800
Mailing Address - Country:US
Mailing Address - Phone:573-608-5058
Mailing Address - Fax:844-912-8618
Practice Address - Street 1:60 PLAZA DR
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1800
Practice Address - Country:US
Practice Address - Phone:573-608-5058
Practice Address - Fax:844-912-8618
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist