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NPI Code Detail

MEDICARE: TYLER WASKOSKY

MEDICARE: TYLER WASKOSKY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist13394-24WI

General Provider Information

NPI Number : 1902352800
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER WASKOSKY
Provider Business Mailing Address
First Line : 7500 W NORTH AVE
Second Line :
City : WAUWATOSA
State : WI
Zip : 53213-1717
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7500 W NORTH AVE
Second Line :
City : WAUWATOSA
State : WI
Zip : 53213-1717
Country : US
Telephone Number : 414-258-6170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2016
Last Update Date : 08/30/2016

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Directions to “ TYLER WASKOSKY ” Practice Location

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