Provider Demographics
NPI:1720836034
Name:LANNING, TYLAR SHELDON
Entity Type:Individual
Prefix:
First Name:TYLAR
Middle Name:SHELDON
Last Name:LANNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12133 ARBOR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RHOME
Mailing Address - State:TX
Mailing Address - Zip Code:76078-6013
Mailing Address - Country:US
Mailing Address - Phone:970-819-3927
Mailing Address - Fax:
Practice Address - Street 1:5520 SYCAMORE SCHOOL RD STE 230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-3062
Practice Address - Country:US
Practice Address - Phone:817-423-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1392030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist