Tyler Belt
Individual provider Active NPI Physical Therapist · Macon, MO
NPI 1306383773 · NPPES record last updated Jan 24, 2017
Key facts
- NPI
- 1306383773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070021987 (IL)
- Practice address
- 1005 Overbrook Dr
Macon, MO 63552-2213 - Phone
- (660) 651-7419
- NPI assigned
- Jan 24, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 070021987 | IL | MD | Physical Therapist |
| 2015027077 | MO | MD | Physical Therapist |
| 5069 | OK | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5069 | OK | |
| Physical Therapist | 225100000X | 2015027077 | MO | |
| Physical Therapist | 225100000X | 070021987 | IL | Yes |
Addresses
Primary practice location
1005 Overbrook Dr
Macon, MO 63552-2213
Mailing address
1005 Overbrook Dr
Macon, MO 63552-2213
Phone (660) 651-7419
Other providers in Macon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2017. 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.