Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT 27504 | FL |
Y | 213ES0000X | Sports Medicine | PT 27504 | FL |
N | 225100000X | Physical Therapist | PT39257 | CA |
NPI | 1336499839 |
---|---|
Provider Name | Dr. Tyler J Opitz |
First Address | Pensacola, FL 32514-5752 |
Second Address | Pensacola, FL 32514-5752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 03/01/2013 |