Provider Demographics
NPI:1760021018
Name:TEMPLETON, KYLER LUKE (LAT)
Entity Type:Individual
Prefix:
First Name:KYLER
Middle Name:LUKE
Last Name:TEMPLETON
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-4527
Mailing Address - Country:US
Mailing Address - Phone:325-370-8212
Mailing Address - Fax:
Practice Address - Street 1:3211 47TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4112
Practice Address - Country:US
Practice Address - Phone:806-219-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59102081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine