Basic Information
| Provider Information | |||||||||
| NPI: | 1144796376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUSE | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 HARCOURT RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430503944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403928811 | ||||||||
| FaxNumber: | 7403926485 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S LANE ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195626686 | ||||||||
| FaxNumber: | 4195626625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2018 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-017682 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.