NPI 1043600919

Tyler Martin, MAATCLAT

Practitioner Athletic Trainer Kenosha, WI

Practice location

Address: 900 Wood Rd, Kenosha, WI 53144-1133
Phone: (262) 595-2164
Fax: (262) 595-2225
Mailing address: 1296 Village Centre Dr Unit 5, Kenosha, WI 53144-7265

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 1310-39 (WI)

Other Specialist/Technologist providers in Wisconsin →

Registry record

NPI: 1043600919
Entity type: Individual
Sex (as registered): Male
NPI issued: 30 Jan 2015
Record last updated: 30 Jan 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.