Provider Demographics
NPI:1114983764
Name:HYATT, MICHAEL CHAD (ATC, EMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHAD
Last Name:HYATT
Suffix:
Gender:M
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 CARA CT
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-9327
Mailing Address - Country:US
Mailing Address - Phone:540-951-2409
Mailing Address - Fax:
Practice Address - Street 1:VIRGINIA TECH SPORTS MEDICINE
Practice Address - Street 2:160 JAMERSON ATHLETIC CENTER
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-0001
Practice Address - Country:US
Practice Address - Phone:540-231-6410
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer