Provider Demographics
NPI:1265079750
Name:BARCZEWSKI, TYLER THOMAS
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:THOMAS
Last Name:BARCZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S MAIN ST APT 912A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3424
Mailing Address - Country:US
Mailing Address - Phone:231-577-8180
Mailing Address - Fax:
Practice Address - Street 1:912 S MAIN ST APT 912A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3424
Practice Address - Country:US
Practice Address - Phone:231-577-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer