Provider Demographics
NPI:1699393819
Name:LINGLE, JON MICHAEL (ATP)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MICHAEL
Last Name:LINGLE
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1535
Mailing Address - Country:US
Mailing Address - Phone:903-216-5053
Mailing Address - Fax:
Practice Address - Street 1:1003 N NORTHEAST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75708-2014
Practice Address - Country:US
Practice Address - Phone:903-352-3788
Practice Address - Fax:903-255-7830
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier