Provider Demographics
NPI:1124315676
Name:DEUSER, TYLER SCOTT (MBA, ATC, LAT, CSCS)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:SCOTT
Last Name:DEUSER
Suffix:
Gender:M
Credentials:MBA, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-8801
Mailing Address - Country:US
Mailing Address - Phone:812-599-0942
Mailing Address - Fax:
Practice Address - Street 1:43 PARADISE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-8801
Practice Address - Country:US
Practice Address - Phone:812-599-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001333A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer