Most Relevant Information
Provider Data
| NPI Number: | 1003510488 |
| Provider Name: | JILLIAN TYLER PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 3720 |
Most Important Dates
| Enumeration Date: | 03/29/2023 |
| Last Updated: | 03/29/2023 |
Provider Practice Location
109 PARK PLACE CT
LEXINGTON
SC
290726690
Practice Location Phone/Fax
| Phone: | 8032564107 |
| Fax: |
Provider Mailing Location
1910 BLANDING ST
COLUMBIA
SC
292013520
Provider Mailing Phone/Fax
| Phone: | 8032564107 |
| Fax: |