Individual
KYLE DOLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
2 MEDICAL PARK RD STE 104, COLUMBIA, SC 29203-6839
(803) 434-6812
(803) 434-7306
Mailing address
1015 CATAWBA CIR, COLUMBIA, SC 29201-5252
(978) 697-4943
(803) 509-6390
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1628
SC
2255A2300X
Athletic Trainer
2000015215
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1628
DHEC STATE CERTIFICATION
SC
01
—
2000015215
BOC LICENSURE
MA
Enumeration date
03/04/2016
Last updated
03/04/2016
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