Provider Demographics
NPI:1598340713
Name:KRAYNIK, TYLER J (CSCS, MES)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:KRAYNIK
Suffix:
Gender:M
Credentials:CSCS, MES
Other - Prefix:
Other - First Name:TY
Other - Middle Name:
Other - Last Name:KRAYNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSCS, MES
Mailing Address - Street 1:1970 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4125
Mailing Address - Country:US
Mailing Address - Phone:920-430-4890
Mailing Address - Fax:
Practice Address - Street 1:1970 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4125
Practice Address - Country:US
Practice Address - Phone:920-430-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist