Provider Demographics
NPI:1851783716
Name:HEALY, TYLER DANIEL (ATC, EMT-B)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:DANIEL
Last Name:HEALY
Suffix:
Gender:M
Credentials:ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 PEPPER DR APT B
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3344
Mailing Address - Country:US
Mailing Address - Phone:559-410-1203
Mailing Address - Fax:
Practice Address - Street 1:653 PEPPER DR APT B
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3344
Practice Address - Country:US
Practice Address - Phone:559-410-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE098290146N00000X, 146N00000X
20000212552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer