Provider Demographics
NPI:1861234353
Name:PAHL, TYLER AUSTIN (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:AUSTIN
Last Name:PAHL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 KARL RIDGE RD APT 717
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7301
Mailing Address - Country:US
Mailing Address - Phone:605-949-1131
Mailing Address - Fax:
Practice Address - Street 1:6800 A ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-5134
Practice Address - Country:US
Practice Address - Phone:402-483-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist