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General NPI Number Information
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NPI Number | 1659151413
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Entity Type | Individual
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Provider Name | TYLER JAMES SKONIECKI LAT, ATC, NREMT-B
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Gender | Male
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 91 STADIUM DR STALLINGS EVANS SPORTS MEDICINE CENTER
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City | CHAPEL HILL
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State | NC
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Zip | 27515
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Country | US
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Telephone | 919-962-2067
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Fax |
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Provider Business Mailing Address
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Address Line | 57 DEER PATH DR
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City | BERWICK
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State | PA
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Zip | 18603-5107
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Country | US
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Telephone | 570-855-4297
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | P561644
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 1059757
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | LAT5788
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License Number State | NC
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