Basic Information
| Provider Information | |||||||||
| NPI: | 1831826304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4645 MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | SLINGER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530869516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622247489 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2725 S MOORLAND RD | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531513720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143292430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2022 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 3275-19 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.