Tyler Gill, LAT, ATC
Individual provider Active NPI Athletic Trainer · West Haven, UT
NPI 1467097568 · NPPES record last updated Nov 12, 2019
Key facts
- NPI
- 1467097568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 3476 W 4600 S
West Haven, UT 84401-9203 - Phone
- (801) 660-3888
- NPI assigned
- Nov 12, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer |
2255A2300X | Yes |
Addresses
Primary practice location
3476 W 4600 S
West Haven, UT 84401-9203
Mailing address
3476 W 4600 S
West Haven, UT 84401-9203
Other providers in West Haven, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.