Provider Demographics
NPI:1902359037
Name:LAMB, TYLER CREEED (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CREEED
Last Name:LAMB
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4059
Mailing Address - Country:US
Mailing Address - Phone:806-273-1093
Mailing Address - Fax:
Practice Address - Street 1:600 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4059
Practice Address - Country:US
Practice Address - Phone:806-273-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT63942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer