Individual
TYLER NUSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 S HAMPTON PL, CLARKSVILLE, TN 37040-6359
(419) 518-0395
Mailing address
216 OHIO DR, BRYAN, OH 43506-8944
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2381
TN
Other
Enumeration date
04/16/2019
Last updated
04/16/2019
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