Individual
TYLER MACDONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4600 TRINITY RD, RALEIGH, NC 27607-3924
(919) 515-3961
(919) 515-8932
Mailing address
4600 TRINITY RD, RALEIGH, NC 27607-3924
(919) 515-3961
(919) 515-8932
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1148
NC
Other
Enumeration date
03/12/2014
Last updated
03/12/2014
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