Individual ProviderTyler J DouglassPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address9630 Grove Cir N Ste 200, Maple Grove, MN 55369-3492(763) 520-7870(952) 847-4029PECOS EnrollmentBased on the most recent information from CMS, provider Tyler J Douglass does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1942714035Provider TypeIndividualFull NameDouglass, Tyler JCredentialPTGenderMaleSole ProprietorNoEnumeration Date11/28/2017Last Updated11/28/2017Contact InformationPractice LocationPractice Address9630 Grove Cir N Ste 200, Maple Grove, MN 55369-3492Phone(763) 520-7870Fax(763) 520-7580Mailing LocationMailing Address4200 Dahlberg Dr Ste 300, Golden Valley, MN 55422-4841Phone(952) 847-4029Fax(952) 847-4067Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense10478Minnesota