Provider Demographics
NPI:1407469455
Name:BARRETT, TYLER JAMES
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 SECURITY BLVD UNIT 16
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54313-2703
Mailing Address - Country:US
Mailing Address - Phone:920-450-2890
Mailing Address - Fax:
Practice Address - Street 1:500 GRANT AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1398
Practice Address - Country:US
Practice Address - Phone:920-685-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant