Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | ||
N | 226300000X | Kinesiotherapist |
NPI | 1598340713 |
---|---|
Provider Name | Tyler J Kraynik |
First Address | Green Bay, WI 54304-4125 |
Second Address | Green Bay, WI 54304-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2021 |
Last Update Date | 10/03/2021 |