Provider Demographics
NPI:1174156368
Name:HANNON, TYLER (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:HANNON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:498 MONMOUTH RD STE 3
Practice Address - Street 2:
Practice Address - City:MILLSTONE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08510-1239
Practice Address - Country:US
Practice Address - Phone:609-613-4811
Practice Address - Fax:609-357-0027
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028354225100000X
NJ40QA02146300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist