Provider Demographics
NPI:1275275240
Name:GATSON, TYRA ANIA
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:ANIA
Last Name:GATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 FANNIN ST APT 1516
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2922
Mailing Address - Country:US
Mailing Address - Phone:214-533-8847
Mailing Address - Fax:
Practice Address - Street 1:8181 FANNIN ST APT 1516
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2922
Practice Address - Country:US
Practice Address - Phone:214-533-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer