Provider Demographics
NPI:1922766609
Name:KIZER, TYESHA MONIQUE (MS, LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:TYESHA
Middle Name:MONIQUE
Last Name:KIZER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3704
Mailing Address - Country:US
Mailing Address - Phone:540-287-1790
Mailing Address - Fax:
Practice Address - Street 1:15 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3313
Practice Address - Country:US
Practice Address - Phone:731-881-7679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer