Provider Demographics
NPI:1528681756
Name:MCFADZEN, TYLER JUNEAU (ATC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JUNEAU
Last Name:MCFADZEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CALVARY
Mailing Address - State:WI
Mailing Address - Zip Code:53057-9605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CALVARY
Practice Address - State:WI
Practice Address - Zip Code:53057-9605
Practice Address - Country:US
Practice Address - Phone:262-951-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2304-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer