Healthcare Provider Details

I. General information

NPI: 1508672882
Provider Name (Legal Business Name): TYLER JAMES SAYLOR LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GARDNER LACY RD
MYRTLE BEACH SC
29579-0915
US

IV. Provider business mailing address

275 PALMETTO GREEN DR
LONGS SC
29568-9014
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-3020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1568
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: