Tyler L Vanderzanden, PT
Individual provider Active NPI Physical Therapist · Appleton, WI
NPI 1992049175 · NPPES record last updated Nov 12, 2012
Key facts
- NPI
- 1992049175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11975-24 (WI)
- Practice address
- 2105 E Enterprise Ave
Suite 113
Appleton, WI 54913-7862 - Phone
- (920) 991-2561
- NPI assigned
- Nov 12, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11975-24 | WI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sarol Ventures LLC | Physical Therapist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11975-24 | WI | Yes |
Addresses
Primary practice location
2105 E Enterprise Ave
Suite 113
Appleton, WI 54913-7862
Mailing address
2105 E Enterprise Ave
Suite 113
Appleton, WI 54913-7862
Phone (920) 991-2561
Other providers in Appleton, WI
- Maria Vanderlinden
- Traci Vanderloop
- Constance Mary Vandermoss
- Catherine Ann Vanderpas
- Wanda L Vanderwyst
- Stephanie Lynn Vandewettering
- Kathleen M. Vandrunen
- Danielle L Vanevenhoven
- Ryan Vanevenhoven
- Maika Vang
All providers in Appleton, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2012. 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.