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General NPI Number Information
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NPI Number | 1356889653
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Entity Type | Individual
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Provider Name | NICHOLAS TYLER MERGEN DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 3290 RIDGEWAY DR STE 3
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City | CORALVILLE
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State | IA
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Zip | 52241-2023
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Country | US
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Telephone | 319-665-2630
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Fax |
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Provider Business Mailing Address
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Address Line | 3290 RIDGEWAY DR STE 3
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City | CORALVILLE
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State | IA
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Zip | 52241-2023
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Country | US
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Telephone | 319-665-2630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 085171
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 082934
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License Number State | IA
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