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NPI Code Detail

MEDICARE: TYLER RAYMAKER DPT, PT

MEDICARE: TYLER RAYMAKER DPT, PT
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 Therapist13966-24WI

General Provider Information

NPI Number : 1023521663
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER RAYMAKER DPT, PT
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-1980
Fax Number :
Provider Business Practice Location Address
First Line : 3701 80TH ST
Second Line :
City : KENOSHA
State : WI
Zip : 53142-4950
Country : US
Telephone Number : 262-697-1730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2017
Last Update Date : 03/17/2018

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