Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 13419-24 | WI |
NPI | 1003269283 |
---|---|
Provider Name | Tyler Allee |
First Address | Madison, WI 53717-1921 |
Second Address | Washington, DC 20036-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2016 |
Last Update Date | 07/01/2022 |