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General NPI Number Information
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NPI Number | 1457835605
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Entity Type | Individual
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Provider Name | TYLER ANHALT ATC
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Gender | Male
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Dates
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Enumeration Date | 09/23/2018
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Last Update Date | 09/23/2018
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Provider Practice Location Address
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Address Line | 120 MEDIA LINE RD
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-4614
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Country | US
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Telephone | 610-325-6434
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 HARDING DR
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City | HAVERTOWN
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State | PA
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Zip | 19083-5221
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Country | US
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Telephone | 484-486-9145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT006342
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License Number State | PA
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