Provider Demographics
NPI:1528608239
Name:REDIGER, TYLER (MED, ATC, LAT, CES)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:REDIGER
Suffix:
Gender:M
Credentials:MED, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WILDERNESS HILL BLVD APT 7-205
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5185
Mailing Address - Country:US
Mailing Address - Phone:402-560-6625
Mailing Address - Fax:
Practice Address - Street 1:2930 S 37TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3230
Practice Address - Country:US
Practice Address - Phone:402-436-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT71902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer