Provider Demographics
NPI:1720296536
Name:TRIBBLE, LARRY KYLE (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:KYLE
Last Name:TRIBBLE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 STATE HIGHWAY 30 W
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-0720
Mailing Address - Country:US
Mailing Address - Phone:936-291-9705
Mailing Address - Fax:
Practice Address - Street 1:441 FM 2821 RD E
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-9223
Practice Address - Country:US
Practice Address - Phone:936-293-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT28842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer