Individual
TYLER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
1400 MONTGOMERY AVE, BRYN MAWR, PA 19010-1631
(610) 527-0200
Mailing address
325 PONDVIEW DR, HARLEYSVILLE, PA 19438-2395
(267) 885-5377
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT006884
PA
Other
Enumeration date
04/25/2016
Last updated
07/12/2019
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