Individual
TYLER DEXTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
5087 S 2870 E, HOLLADAY, UT 84117-7161
(555) 555-5555
Mailing address
5087 S 2870 E, HOLLADAY, UT 84117-7161
(555) 555-5551
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
9072143-4810
UT
Other
Enumeration date
02/11/2013
Last updated
09/24/2019
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