Individual provider Active NPI

Tyler Hettich, DPT

  • Physical Therapist
  • Warrendale, PA
National Provider Identifier
1629831680
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
802 Warrendale Village Dr
Warrendale, PA 15086-7589
Phone
(724) 719-2326
Fax
(724) 719-2356
NPI assigned
Feb 2, 2024
Last updated
May 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PTL.0020484 CO
Physical Therapist 225100000X Primary

Addresses

Primary practice location

802 Warrendale Village Dr
Warrendale, PA 15086-7589

Mailing address

470 Johnson Rd Ste 140
Washington, PA 15301-8977
Phone (724) 223-2061

Other practice location 1

12905 W 40th Ave Ste 520
Golden, CO 80401-2790
Phone (303) 665-2603

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250409003247 CO Practitioner - Physical Therapist in Private Practice 4789108911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3 Superior Dr
Suite 225
Superior, CO 80027-8661
Phone (303) 665-2603

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Centers of Colorado, LLC Physical Therapist CurrentSince Apr 29, 2025 Accepting new patients
Orthopedic Centers of Colorado, LLC Physical Therapist CurrentSince Apr 29, 2025 Accepting new patients
The Physical Therapy Institute PastSince Feb 4, 2024 Accepting new patients
Sports Medicine & Joint Replacement Specialists Corporation PastSince Feb 4, 2024 Accepting new patients

Locations

1411 S Potomac St
Ste 350
Aurora, CO 80012
Phone (303) 671-2134

12905 W 40th Ave
Ste 520
Golden, CO 80401
Phone (720) 593-3998

8101 E Lowry Blvd
Ste 120
Lowry, CO 80230
Phone (303) 806-1998

3 Superior Dr
Ste 225
Superior, CO 80027
Phone 3036652603106

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1629831680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 JOHNSON RD STE 140",
            "city": "WASHINGTON",
            "state": "PA",
            "postal_code": "153018977",
            "telephone_number": "724-223-2061",
            "fax_number": "724-223-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 WARRENDALE VILLAGE DR",
            "city": "WARRENDALE",
            "state": "PA",
            "postal_code": "150867589",
            "telephone_number": "724-719-2326",
            "fax_number": "724-719-2356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12905 W 40th Ave Ste 520",
            "address_purpose": "LOCATION",
            "city": "Golden",
            "state": "CO",
            "postal_code": "804012790",
            "country_code": "US",
            "telephone_number": "303-665-2603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HETTICH",
        "first_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-02",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0020484",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warrendale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.