Individual
TYLER AUSTIN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1300 WHEAT ST, OFFICE 214, COLUMBIA, SC 29208-0001
(636) 699-0078
Mailing address
1300 WHEAT ST, OFFICE 214, COLUMBIA, SC 29208-0001
(636) 699-0078
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000025534
MO
Other
Enumeration date
11/14/2016
Last updated
11/14/2016
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