Provider Demographics
NPI:1962545087
Name:SWETT, TYLER D (ATC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:D
Last Name:SWETT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-0031
Mailing Address - Country:US
Mailing Address - Phone:207-608-0506
Mailing Address - Fax:
Practice Address - Street 1:388 SOMERSWORTH RD
Practice Address - Street 2:
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906-6559
Practice Address - Country:US
Practice Address - Phone:207-676-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT3012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAT301OtherATHLETIC TRAINING LICENSE