Provider Demographics
NPI:1689414344
Name:CLAYCOMB, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CLAYCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 POTTSTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-9518
Mailing Address - Country:US
Mailing Address - Phone:610-424-1100
Mailing Address - Fax:
Practice Address - Street 1:1130 MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4022
Practice Address - Country:US
Practice Address - Phone:610-424-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist