Ty Wasmuth
Individual provider Active NPI Athletic Trainer · Brillion, WI
NPI 1306228341 · NPPES record last updated Jun 26, 2015
Key facts
- NPI
- 1306228341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- W2538059201008 (WI)
- Practice address
- 24138 Blue Heron Dr
Brillion, WI 54110-9316 - Phone
- (920) 901-7843
- NPI assigned
- Jun 26, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| W2538059201008 | WI | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | W2538059201008 | WI | Yes |
Addresses
Primary practice location
24138 Blue Heron Dr
Brillion, WI 54110-9316
Mailing address
24138 Blue Heron Dr
Brillion, WI 54110-9316
Other providers in Brillion, WI
- Shopko Stores Operating Co LLC
- Christopher John Sipple
- T.J. Kalies
- Vernon J. Goin D.D.S. S.C.
- Jacob R Warrens
- Kylee Marie Watkins
All providers in Brillion, WI · Athletic Trainer in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.