Tyler Conley, PTA – Physical Therapy Assistant

Key facts

NPI: 1114749314
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapy Assistant 225200000X
License: 3355 (OK)
Practice address: 103 W Main St
Marlow, OK 73055-2437
Phone: (580) 721-7100
NPI assigned: Oct 29, 2024
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Blue Rock Health and Wellness LLC Physical Therapy Clinic/Center · Marlow, OK · NPI 1578046827

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
3355	OK	MD	Professional Counselor

Practice roles

Organization	Specialty	Status	New patients
Blue Rock Health and Wellness LLC		Current since Nov 3, 2024	Accepting new patients

Locations

103 W Main St
Marlow, OK 73055
Phone (580) 658-2319

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapy Assistant	225200000X	3355	OK	Yes

Addresses

Primary practice location

103 W Main St
Marlow, OK 73055-2437

Mailing address

1186 County Road 1560
Rush Springs, OK 73082-3038
Phone (580) 861-2504

Other providers in Marlow, OK

All providers in Marlow, OK · Physical Therapy Assistant in Oklahoma

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.