Provider Demographics
NPI:1881077519
Name:NANCE, TYLER (DPT, PT, ATC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:NANCE
Suffix:
Gender:M
Credentials:DPT, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 E SHANNON WOODS CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4105
Mailing Address - Country:US
Mailing Address - Phone:316-681-0824
Mailing Address - Fax:
Practice Address - Street 1:10100 E SHANNON WOODS CIR STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4105
Practice Address - Country:US
Practice Address - Phone:316-681-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
KS11-06270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer