Individual
TYLER JOHN BAUMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1540 6TH ST E, SAINT PAUL, MN 55106-4850
(952) 449-1054
Mailing address
1704 CRESTVIEW ST, SHAKOPEE, MN 55379-4320
(952) 449-1054
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920798698
MEDICA
—
Enumeration date
01/15/2019
Last updated
02/17/2021
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