Provider Demographics
NPI:1871642249
Name:THOMSON, TYANN C (MS, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:TYANN
Middle Name:C
Last Name:THOMSON
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:TYANN
Other - Middle Name:C
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24787 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-6660
Mailing Address - Country:US
Mailing Address - Phone:256-975-1789
Mailing Address - Fax:256-265-7020
Practice Address - Street 1:925 FRANKLIN ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4302
Practice Address - Country:US
Practice Address - Phone:256-265-5000
Practice Address - Fax:256-265-7020
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL15202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN120602631OtherATC