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General NPI Number Information
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NPI Number | 1396387890
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Entity Type | Organization
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Legal Business Name | TOM LORREN III PC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 508 S SPRING AVE
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City | TYLER
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State | TX
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Zip | 75702-8140
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Country | US
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Telephone | 903-747-8488
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Fax | 888-330-1060
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Provider Business Mailing Address
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Address Line | 6850 COUNTY ROAD 4328
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City | LARUE
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State | TX
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Zip | 75770-4375
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Country | US
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Telephone | 903-747-8488
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Fax | 888-330-1060
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LINDA SUE LORREN
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Credential |
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Telephone | 903-747-8488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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