Provider Demographics
NPI:1659470631
Name:TAYAG, GERARD SAMIANO (PT)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:SAMIANO
Last Name:TAYAG
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 1:1910 75TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1612
Mailing Address - Country:US
Mailing Address - Phone:806-748-5474
Mailing Address - Fax:
Practice Address - Street 1:4601 S LOOP 289 STE 11
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2206
Practice Address - Country:US
Practice Address - Phone:806-792-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist