Provider Demographics
NPI:1548960552
Name:MOK, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CITRUS TOWER BLVD APT 21205
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7003
Mailing Address - Country:US
Mailing Address - Phone:347-993-0751
Mailing Address - Fax:
Practice Address - Street 1:711 S HWY 27 STE C
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2791
Practice Address - Country:US
Practice Address - Phone:689-244-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist