Individual
TYLER WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT
Contact information
Practice address
800 E LANCASTER AVE, JAKE NEVIN FIELD HOUSE, VILLANOVA, PA 19085-1603
(610) 519-5384
Mailing address
800 E LANCASTER AVE, JAKE NEVIN FIELD HOUSE, VILLANOVA, PA 19085-1603
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RTO000082
PA
Other
Enumeration date
01/20/2015
Last updated
01/20/2015
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