Provider Demographics
NPI:1871722785
Name:BENZ, TYLER WILLIAM
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:WILLIAM
Last Name:BENZ
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 1:12941 NORTH FWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1240
Mailing Address - Country:US
Mailing Address - Phone:832-253-1188
Mailing Address - Fax:832-253-1181
Practice Address - Street 1:12941 NORTH FWY
Practice Address - Street 2:SUITE 401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1240
Practice Address - Country:US
Practice Address - Phone:832-253-1188
Practice Address - Fax:832-253-1181
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2044634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant