Individual
TYLER VAN BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2100 LOUISIANA BLVD NE STE 410, ALBUQUERQUE, NM 87110-5412
(505) 724-4300
Mailing address
5120 ALBERTA AVE NE, RIO RANCHO, NM 87144-6482
(505) 615-6368
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5730
NM
Other
Enumeration date
07/19/2020
Last updated
07/19/2020
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