Provider Demographics
NPI:1487334470
Name:TYLER, GRETCHEN
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 CAMBER RD
Mailing Address - Street 2:
Mailing Address - City:HUGER
Mailing Address - State:SC
Mailing Address - Zip Code:29450-8525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:247 CAMBER RD
Practice Address - Street 2:
Practice Address - City:HUGER
Practice Address - State:SC
Practice Address - Zip Code:29450-8525
Practice Address - Country:US
Practice Address - Phone:843-693-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist