Healthcare Provider Details

I. General information

NPI: 1740657790
Provider Name (Legal Business Name): TYLER JOEL BRITT ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BEAMAN ST
CLINTON NC
28328-2602
US

IV. Provider business mailing address

3070 DOBBERSVILLE RD
MOUNT OLIVE NC
28365-7378
US

V. Phone/Fax

Practice location:
  • Phone: 910-596-5633
  • Fax:
Mailing address:
  • Phone: 919-738-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-2517
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: