MEDICARE: ROBERT TYLER HAMILTON MS, 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	AL 2197	FL

General Provider Information

NPI Number	:	1558404350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT TYLER HAMILTON MS, ATC

Provider Business Mailing Address
First Line	:	600 S DIXIE HWY
Second Line	:	APT. 427
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S FLAGLER DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-6505
Country	:	US
Telephone Number	:	561-803-2378
Fax Number	:	561-803-2370

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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