Provider Demographics
NPI:1326181983
Name:TYNER, WILLIAM TAFT JR (ATC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TAFT
Last Name:TYNER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9910 CERVIDAE LN APT 102
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1954
Mailing Address - Country:US
Mailing Address - Phone:410-922-6139
Mailing Address - Fax:
Practice Address - Street 1:4300 HAREWOOD RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1513
Practice Address - Country:US
Practice Address - Phone:202-368-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer