Provider Demographics
NPI:1326421066
Name:FIELDS, TRYON (PT)
Entity Type:Individual
Prefix:
First Name:TRYON
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12381 S US HIGHWAY 277
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-4498
Mailing Address - Country:US
Mailing Address - Phone:619-547-7039
Mailing Address - Fax:325-225-0613
Practice Address - Street 1:4105 S CHADBOURNE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-9152
Practice Address - Country:US
Practice Address - Phone:619-547-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3118188225100000X
TX1262617261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist