Provider Demographics
NPI:1679093785
Name:LOWRANCE, TYSON J (DPT)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:J
Last Name:LOWRANCE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 CHARLOTTE HWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7803
Mailing Address - Country:US
Mailing Address - Phone:803-548-5668
Mailing Address - Fax:803-548-5668
Practice Address - Street 1:7580 CHARLOTTE HWY STE 1100
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7803
Practice Address - Country:US
Practice Address - Phone:803-548-5662
Practice Address - Fax:803-548-5635
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist