Tyler Emerson Mellecker, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

27302 Issued in FL

Practice address

20973 Corkscrew Shores Blvd
Estero, FL 33928-9146

Phone

(630) 687-0574

Fax

(239) 320-3231

NPI assigned

Mar 6, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Tyler Emerson Mellecker Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Teeko, LLC

  • Physical Therapy Clinic/Center
  • Estero, FL
  • NPI 1710772132
  Medicare reassignment NPD

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

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1760280481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20973 CORKSCREW SHORES BLVD",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339289146",
            "telephone_number": "630-687-0574",
            "fax_number": "239-320-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20973 CORKSCREW SHORES BLVD",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339289146",
            "telephone_number": "630-687-0574",
            "fax_number": "239-320-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLECKER",
        "first_name": "TYLER",
        "middle_name": "EMERSON",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "FL",
            "license": "27302",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "27302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TYLER",
            "last_name": "MELLECKER",
            "middle_name": "EMERSON",
            "prefix": "MR.",
            "credential": "TYLER E. MELLECKER",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kelly McBride, BSN, RN, IBCLC
• Marianne McCaw, LMHC
• Robin Fatovic McDermott, PSY.D.
• Martin John McKenna, M.D.
• Medfit, LLC
• Eluar Mendez Hernandez
• Javier Mendez
• Mental Wellness Group, LLC
• Meredyth Acri PT LLC
• Glen Franklin Metrick, PHYSICAL THERAPIST

• Physical Therapy Assistant in Estero, FL
• Providers in Estero, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.