Individual
TYLER PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
12846 3600 W, RIVERTON, UT 84065
(404) 820-3570
Mailing address
1831 E 3170 S, MILLCREEK, UT 84106-3776
(404) 820-3570
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
14176484-1206
UT
Other
Enumeration date
07/02/2018
Last updated
05/05/2026
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