MEDICARE: TYLER JAMES SAYLOR 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
1	2255A2300X	Athletic Trainer	1568	SC

General Provider Information

NPI Number	:	1508672882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JAMES SAYLOR LAT, ATC

Provider Business Mailing Address
First Line	:	275 PALMETTO GREEN DR
Second Line	:
City	:	LONGS
State	:	SC
Zip	:	29568-9014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 GARDNER LACY RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-0915
Country	:	US
Telephone Number	:	843-236-3020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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