Provider Demographics
NPI:1053519132
Name:TYNDALL, JAMES ALAN (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:TYNDALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:12505 OLD MERIDIAN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8799
Practice Address - Country:US
Practice Address - Phone:317-819-9500
Practice Address - Fax:317-819-9501
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008052A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201002700Medicaid
M400029125Medicare PIN