Provider Demographics
NPI:1659870624
Name:GRIFFIN, TYLER BLAKE (ATC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:BLAKE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 COUNTY HWY 46
Mailing Address - Street 2:
Mailing Address - City:BRILLIANT
Mailing Address - State:AL
Mailing Address - Zip Code:35548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:392 SOUTH DONAHUE DRIVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36849
Practice Address - Country:US
Practice Address - Phone:334-844-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer