Provider Demographics
NPI:1720863525
Name:WOLFF, TYLER NELSON (CPT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:NELSON
Last Name:WOLFF
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BONNET MEADOW CV
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4381
Mailing Address - Country:US
Mailing Address - Phone:737-932-2733
Mailing Address - Fax:
Practice Address - Street 1:110 INNER CAMPUS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1139
Practice Address - Country:US
Practice Address - Phone:737-932-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program