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NPI Code Detail

MEDICARE: TYLER GILL LAT, ATC

MEDICARE: TYLER GILL LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1467097568
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER GILL LAT, ATC
Provider Business Mailing Address
First Line : 3476 W 4600 S
Second Line :
City : WEST HAVEN
State : UT
Zip : 84401-9203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3476 W 4600 S
Second Line :
City : WEST HAVEN
State : UT
Zip : 84401-9203
Country : US
Telephone Number : 801-660-3888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2019
Last Update Date : 11/12/2019

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Directions to “ TYLER GILL LAT, ATC” Practice Location

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