Provider Demographics
NPI:1043195423
Name:GARRY, TYLER MICHAEL
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:MICHAEL
Last Name:GARRY
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 1:707 COUNTRY SIDE LN APT 106
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2590
Mailing Address - Country:US
Mailing Address - Phone:860-302-8453
Mailing Address - Fax:
Practice Address - Street 1:250 CENTERVILLE RD BLDG A
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4353
Practice Address - Country:US
Practice Address - Phone:401-384-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist