Healthcare Provider Details

I. General information

NPI: 1144146051
Provider Name (Legal Business Name): LYNSEY BRYCE TILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 UNIVERSITY BLVD
NORTH CHARLESTON SC
29406-9121
US

IV. Provider business mailing address

1443 FIREMAN WAY
LAMAR SC
29069-9722
US

V. Phone/Fax

Practice location:
  • Phone: 843-687-3576
  • Fax:
Mailing address:
  • Phone: 843-687-3576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: