NPI 1053864306

Michael Tyler Wilson, ATCLAT

Practitioner Athletic Trainer Fayette, MO

Practice location

Address: 411 Central Methodist Sq, Fayette, MO 65248-1104
Phone: (636) 577-5062

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 2016023484 (MO)

Other Specialist/Technologist providers in Missouri →

Registry record

NPI: 1053864306
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Aug 2016
Record last updated: 3 Aug 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.