Provider Demographics
NPI:1275024432
Name:JONS, TYRA LARAE (ATC)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:LARAE
Last Name:JONS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:TYRA
Other - Middle Name:LARAE
Other - Last Name:PATZLAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2120 LIVE STRONGER ST
Mailing Address - Street 2:
Mailing Address - City:TEA
Mailing Address - State:SD
Mailing Address - Zip Code:57064-8331
Mailing Address - Country:US
Mailing Address - Phone:605-331-5890
Mailing Address - Fax:
Practice Address - Street 1:2120 LIVE STRONGER ST
Practice Address - Street 2:
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-8331
Practice Address - Country:US
Practice Address - Phone:605-331-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05922255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD01324319OtherDRIVERS LICENSE