Provider Demographics
NPI:1154383628
Name:LORREN, THOMAS ALTON III (PT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALTON
Last Name:LORREN
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:566 HIDE A WAY LN E
Mailing Address - Street 2:
Mailing Address - City:HIDEAWAY
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5242
Mailing Address - Country:US
Mailing Address - Phone:903-720-7977
Mailing Address - Fax:
Practice Address - Street 1:3206 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5143
Practice Address - Country:US
Practice Address - Phone:903-753-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1589492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic