Individual
TYLER HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
120 HARDWOOD DR, LEWISBURG, PA 17837-5030
(570) 556-4191
Mailing address
18415 CUB CIR, BLOOMSBURG, PA 17815-8339
(219) 973-8033
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT006691
PA
Other
Enumeration date
10/08/2017
Last updated
10/08/2017
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