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General NPI Number Information
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NPI Number | 1487470118
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Entity Type | Individual
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Provider Name | BOSTON TYLER FOLLIS
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Gender | Male
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1 CUMBERLAND SQ
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City | LEBANON
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State | TN
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Zip | 37087-3408
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Country | US
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Telephone | 615-444-2562
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Fax |
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Provider Business Mailing Address
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Address Line | 4385 THICK RD
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City | CHAPEL HILL
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State | TN
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Zip | 37034-2677
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Country | US
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Telephone | 414-520-6440
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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