Individual
MRS. TERESA TYRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
740 E LAUREL RD, LONDON, KY 40741-8601
(606) 877-3950
(606) 877-3956
Mailing address
PO BOX 2328, LONDON, KY 40743-2328
(606) 877-3950
(606) 877-3956
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A00638
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A00638
STATE LICENSE
KY
Enumeration date
06/22/2007
Last updated
07/08/2007
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