Provider Demographics
NPI:1740793876
Name:ARNOLD, TYLER (ATC, LAT, EMT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:ATC, LAT, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:772 STRACKS DAM RD
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-2170
Mailing Address - Country:US
Mailing Address - Phone:717-926-3024
Mailing Address - Fax:
Practice Address - Street 1:2913 SPOOKY NOOK RD STE 100
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-9149
Practice Address - Country:US
Practice Address - Phone:717-299-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0068352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA174823OtherEMT