Provider Demographics
NPI:1881308104
Name:NELTNER, TYLER J (ATC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:NELTNER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 FLETCHER AVE APT 389
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4668
Mailing Address - Country:US
Mailing Address - Phone:859-640-9678
Mailing Address - Fax:
Practice Address - Street 1:3233 FLETCHER AVE APT 389
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4668
Practice Address - Country:US
Practice Address - Phone:859-640-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL50582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer