Individual
TYLER NELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPED4584
Contact information
Practice address
9810 COUNTY ROAD D, BRUSSELS, WI 54204-9511
(920) 445-5515
Mailing address
9810 CTY RD D, BRUSSELS, WI 54204
(920) 445-5515
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
CPED4584
WI
Other
Enumeration date
10/22/2024
Last updated
10/22/2024
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