Provider Demographics
NPI:1780154856
Name:THOMAS BARKER, LILLIAN (AT)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:THOMAS BARKER
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11434 CULEBRA RD APT 6108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6165
Mailing Address - Country:US
Mailing Address - Phone:949-302-8137
Mailing Address - Fax:
Practice Address - Street 1:2239 WALKER AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-5632
Practice Address - Country:US
Practice Address - Phone:949-302-8137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty