Provider Demographics
NPI:1972737435
Name:WASMER, TYLER LAWRENCE (DPT)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:LAWRENCE
Last Name:WASMER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19049 E VALLEY VIEW PKWY
Mailing Address - Street 2:STE H
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7026
Mailing Address - Country:US
Mailing Address - Phone:816-795-8944
Mailing Address - Fax:816-795-8633
Practice Address - Street 1:19049 E VALLEY VIEW PKWY
Practice Address - Street 2:STE H
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7026
Practice Address - Country:US
Practice Address - Phone:816-795-8944
Practice Address - Fax:816-795-8633
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008025216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-6648OtherMEDICARE GROUP NUMBER