Provider Demographics
NPI:1013200674
Name:CREEL, TYLER (BA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CREEL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 ROBERTA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6802
Mailing Address - Country:US
Mailing Address - Phone:775-331-6252
Mailing Address - Fax:775-331-6250
Practice Address - Street 1:895 ROBERTA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6802
Practice Address - Country:US
Practice Address - Phone:775-331-6252
Practice Address - Fax:775-331-6250
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner