Tyler Maddock, PTA
Individual provider Active NPI Physical Therapist · Troy, MI
NPI 1194595066 · NPPES record last updated Jan 3, 2024
Key facts
- NPI
- 1194595066
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5502008520 (MI)
- Practice address
- 3144 John R Rd Ste 200
Troy, MI 48083-5936 - Phone
- (248) 743-0850
- NPI assigned
- Jan 3, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 5502008520 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 1St Choice Physical Therapy Troy, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
1773 Star Batt Dr
Rochester Hills, MI 48309
Phone (248) 650-4720
3144 John R Rd
Ste 200
Troy, MI 48083
Phone (248) 743-0850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5502008520 | MI | Yes |
Addresses
Primary practice location
3144 John R Rd Ste 200
Troy, MI 48083-5936
Mailing address
1773 Star Batt Dr
Rochester Hills, MI 48309-3708
Phone (248) 601-9207
Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 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.