Jackson Wallace Tyler, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8153 Issued in SC

Practice address

445 Savannah Hwy
Charleston, SC 29407

Phone

(843) 766-2121

NPI assigned

Aug 4, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Colorado Luna Care Physical Therapy LLC

  • Physical Therapist
  • Denver, CO
  • NPI 1891461125
  Medicare reassignment NPD
• Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1083021083
  Medicare reassignment NPD
• Intermountain Medical Group Denver, LLC

  dba Orthopedic Centers of Colorado - Saint Joseph

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Denver, CO
  • NPI 1083598874
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1518411818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800022",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641800022",
            "telephone_number": "800-953-0104",
            "fax_number": "303-765-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 SAVANNAH HWY",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-766-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17230 Jackson Creek Pkwy Ste 170",
            "address_purpose": "LOCATION",
            "city": "Monument",
            "state": "CO",
            "postal_code": "801327303",
            "country_code": "US",
            "telephone_number": "719-571-7080",
            "fax_number": "719-571-7089",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4105 Briargate Pkwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809203487",
            "country_code": "US",
            "telephone_number": "719-571-8888",
            "fax_number": "719-571-8889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYLER",
        "first_name": "JACKSON",
        "middle_name": "WALLACE",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-04",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "8153",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0018085",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles T Tweel, M.D.
• Two Caring Hearts Home Health
• Two Wolves Collaborative, LLC
• Joyce Windsor Tye
• Charmella L Tyler, LMSW
• Michael Owens Tyler III, MD
• Robert Sean Ross Tyler, MD
• Anna Weston Tyner, OTR/L
• Taryn Elizabeth Tyner, M.D.
• William Randolph Tyor, MD

• Physical Therapist in Charleston, SC
• Providers in Charleston, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.