Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013200674 |
---|---|
Provider Name | Tyler Creel |
First Address | Sparks, NV 89431-6802 |
Second Address | Sparks, NV 89431-6802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2011 |
Last Update Date | 16/05/2011 |