Provider Demographics
NPI:1851922298
Name:CARROLL, TYSHA WOODS (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:TYSHA
Middle Name:WOODS
Last Name:CARROLL
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 E 8230 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-0679
Mailing Address - Country:US
Mailing Address - Phone:801-413-8300
Mailing Address - Fax:
Practice Address - Street 1:3000 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4400
Practice Address - Country:US
Practice Address - Phone:801-413-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10866759-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer