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General NPI Number Information
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NPI Number | 1528608239
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Entity Type | Individual
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Provider Name | TYLER REDIGER MED, ATC, LAT, CES
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Gender | Male
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 2930 S 37TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-3230
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Country | US
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Telephone | 402-436-1359
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 WILDERNESS HILL BLVD APT 7-205
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City | LINCOLN
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State | NE
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Zip | 68516-5185
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Country | US
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Telephone | 402-560-6625
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7190
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License Number State | TX
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