Provider Demographics
NPI:1295983682
Name:SLAUGHTER, LYNN ROBERT (MT104129)
Entity type:Individual
Prefix:MR
First Name:LYNN
Middle Name:ROBERT
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:MT104129
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 RJ DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-3883
Mailing Address - Country:US
Mailing Address - Phone:806-353-1808
Mailing Address - Fax:806-353-1808
Practice Address - Street 1:9201 RJ DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-3883
Practice Address - Country:US
Practice Address - Phone:806-353-1808
Practice Address - Fax:806-353-1808
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT104129225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist