Healthcare Provider Details

I. General information

NPI: 1932590742
Provider Name (Legal Business Name): WILLIAM LYONS LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 TAFT BLVD
WICHITA FALLS TX
76308-2036
US

IV. Provider business mailing address

3410 TAFT BLVD
WICHITA FALLS TX
76308-2036
US

V. Phone/Fax

Practice location:
  • Phone: 940-397-4824
  • Fax: 940-397-4901
Mailing address:
  • Phone: 940-397-4824
  • Fax: 940-397-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: