Provider Demographics
NPI:1205103074
Name:NEUMANN, TYSON (ATC-L)
Entity type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:NEUMANN
Suffix:
Gender:M
Credentials:ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 S 900 E
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5754
Mailing Address - Country:US
Mailing Address - Phone:855-432-5632
Mailing Address - Fax:
Practice Address - Street 1:6717 S 900 E
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5754
Practice Address - Country:US
Practice Address - Phone:855-432-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT34776548102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer