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Individual

DENISE TYLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7919 FAYETTE ST, PHILA, PA 19150-2103
(267) 402-0108
Mailing address
7919 FAYETTE ST, PHILA, PA 19150-2103
(267) 402-0108

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
JI112924P6
PA

Other

Enumeration date
11/15/2016
Last updated
11/15/2016
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