1508347287 NPI number — TYLER JAMES SYLTIE LAT/ATC

Table of content: TYLER JAMES SYLTIE LAT/ATC (NPI 1508347287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508347287 NPI number — TYLER JAMES SYLTIE LAT/ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYLTIE
Provider First Name:
TYLER
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAT/ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508347287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 RIVERWALK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53072-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-640-4488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4855 W ELECTRIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53219-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-640-4488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  029702576 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 029702576 . This is a "EMPLOYEES OF GE" identifier . This identifiers is of the category "OTHER".