Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | LA4433 | LA |
N | 2251S0007X | Physical Therapist - Sports | LA4433 | LA |
N | 2251X0800X | Physical Therapist - Orthopedic | LA4433 | LA |
NPI | 1043236714 |
---|---|
Provider Name | Mr. Charles Thomas Tyner |
First Address | Mandeville, LA 70471-7431 |
Second Address | La Place, LA 70068-3823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |