Provider Demographics
NPI:1942750625
Name:NEALER, AUSTYN
Entity Type:Individual
Prefix:
First Name:AUSTYN
Middle Name:
Last Name:NEALER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HARBOUR TOWN DR
Mailing Address - Street 2:#318
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2110
Mailing Address - Country:US
Mailing Address - Phone:720-412-2660
Mailing Address - Fax:
Practice Address - Street 1:1440 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2051
Practice Address - Country:US
Practice Address - Phone:608-224-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1841-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841-39OtherPROFESSIONAL LICENSE/CREDENTIAL FOR ATHLETIC TRAINING
2000014527OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER