Provider Demographics
NPI:1932563897
Name:LOZANO, PHILLIP MICHAEL (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:LOZANO
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 1:403 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARMAN
Mailing Address - State:TX
Mailing Address - Zip Code:79081-4021
Mailing Address - Country:US
Mailing Address - Phone:806-659-3233
Mailing Address - Fax:
Practice Address - Street 1:403 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:SPEARMAN
Practice Address - State:TX
Practice Address - Zip Code:79081-4021
Practice Address - Country:US
Practice Address - Phone:806-659-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT47612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer