1275011173 NPI number — TYLER JOHN SAVAKINAS DPT

Table of content: TYLER JOHN SAVAKINAS DPT (NPI 1275011173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275011173 NPI number — TYLER JOHN SAVAKINAS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVAKINAS
Provider First Name:
TYLER
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275011173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 DERRY ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-839-2110
Provider Business Mailing Address Fax Number:
717-565-1934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 NORTHEAST DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033-2758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-533-0215
Provider Business Practice Location Address Fax Number:
717-533-0218
Provider Enumeration Date:
08/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT027064 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)