Provider Demographics
NPI:1487237525
Name:LOWE, TYLER STEPHEN (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:STEPHEN
Last Name:LOWE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5774 FONTANA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-2481
Mailing Address - Country:US
Mailing Address - Phone:478-595-3858
Mailing Address - Fax:
Practice Address - Street 1:5774 FONTANA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-2481
Practice Address - Country:US
Practice Address - Phone:478-595-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0037342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT003734OtherGEORGIA SECRETARY OF STATE