Provider Demographics
NPI:1679391916
Name:MICHOT, TYLER MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:MICHAEL
Last Name:MICHOT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8628 ANGEL GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3144
Mailing Address - Country:US
Mailing Address - Phone:318-452-4514
Mailing Address - Fax:
Practice Address - Street 1:5612 EDWARDS RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4146
Practice Address - Country:US
Practice Address - Phone:318-452-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1374092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist