MEDICARE: TYLER WEBB ATC, LAT

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer	AT7113	TX

General Provider Information

NPI Number	:	1821534595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER WEBB ATC, LAT

Provider Business Mailing Address
First Line	:	3100 CULLEN BLVD STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77204-6002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 S WEST SHORE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7641
Country	:	US
Telephone Number	:	813-770-9617
Fax Number	:

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	06/07/2017

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