Healthcare Provider Details

I. General information

NPI: 1720499254
Provider Name (Legal Business Name): TYLER J KRAUSERT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 COMMANCHE AVE
GREEN BAY WI
54313-5753
US

IV. Provider business mailing address

1630 COMMANCHE AVE
GREEN BAY WI
54313-5753
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-4700
  • Fax: 920-430-4747
Mailing address:
  • Phone: 920-430-4700
  • Fax: 920-430-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: