Provider Demographics
NPI:1861389371
Name:COLGAN, TYLER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:COLGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W YEARLING RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8629
Mailing Address - Country:US
Mailing Address - Phone:602-616-2879
Mailing Address - Fax:
Practice Address - Street 1:1905 W YEARLING RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8629
Practice Address - Country:US
Practice Address - Phone:602-616-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist