Individual
DR. JACKSON WALLACE TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
445 SAVANNAH HWY, CHARLESTON, SC 29407
(843) 766-2121
Mailing address
PO BOX 800022, KANSAS CITY, MO 64180-0022
(800) 953-0104
(303) 765-6670
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8153
SC
225100000X
Physical Therapist
PTL.0018085
CO
Other
Enumeration date
08/04/2016
Last updated
01/06/2022
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