Active NPI
Tyler Hanson, MS, ATC, LAT
- Athletic Trainer
- Lewisburg, PA
National Provider Identifier
1073023792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT006691
- Practice address
- 120 Hardwood Dr
Lewisburg, PA 17837-5030 - Phone
- (570) 556-4191
- NPI assigned
- Oct 8, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT006691 | PA | Primary |
Addresses
Primary practice location
120 Hardwood Dr
Lewisburg, PA 17837-5030
Mailing address
18415 Cub Cir
Bloomsburg, PA 17815-8339
Phone (219) 973-8033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT006691 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507420800000",
"number": "1073023792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18415 CUB CIR",
"city": "BLOOMSBURG",
"state": "PA",
"postal_code": "178158339",
"telephone_number": "219-973-8033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 HARDWOOD DR",
"city": "LEWISBURG",
"state": "PA",
"postal_code": "178375030",
"telephone_number": "570-556-4191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSON",
"first_name": "TYLER",
"credential": "MS, ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-08",
"last_updated": "2017-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT006691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.