Provider Demographics
NPI:1023566676
Name:VANNUCCI, TYLER (LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:VANNUCCI
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 DAWSON ST
Mailing Address - Street 2:APT 6
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3609 DAWSON ST
Practice Address - Street 2:APT 6
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-4143
Practice Address - Country:US
Practice Address - Phone:717-406-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0072672255A2300X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer