Active NPI
Tyler Roseberry
- Athletic Trainer
- Harrisburg, PA
National Provider Identifier
1609321363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT005837
- Practice address
- 626 Rutherford Rd
Harrisburg, PA 17109-5227 - Phone
- (717) 541-1662
- NPI assigned
- Aug 23, 2016
- Sex
- Male
- Sole proprietor
- No
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 | RT005837 | PA | Primary |
Addresses
Primary practice location
626 Rutherford Rd
Harrisburg, PA 17109-5227
Mailing address
142 S 8TH St
Phillipsburg, NJ 08865-1830
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT005837 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471910400000",
"number": "1609321363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 S 8TH ST",
"city": "PHILLIPSBURG",
"state": "NJ",
"postal_code": "088651830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 RUTHERFORD RD",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171095227",
"telephone_number": "717-541-1662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSEBERRY",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-23",
"last_updated": "2016-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT005837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harrisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.