Tyler Clyde Condon, DPT
Individual provider Active NPI Physical Therapist · Andover, KS
NPI 1467714451 · NPPES record last updated Nov 15, 2013
Key facts
- NPI
- 1467714451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1104396 (KS)
- Practice address
- 550 N Andover Rd
Andover, KS 67002-9712 - Phone
- (316) 202-0195
- Fax
- (316) 202-0196
- NPI assigned
- Jun 14, 2012
- 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)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104396 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced PT Pca, LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1104396 | KS | Yes |
Addresses
Primary practice location
550 N Andover Rd
Andover, KS 67002-9712
Mailing address
200 W Douglas Ave
Ste 1040
Wichita, KS 67202-3013
Phone (316) 263-0003
Other providers in Andover, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2013. 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.