Individual
TYLER LOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC, LAT
Contact information
Practice address
12112 W KELLOGG ST, WICHITA, KS 67235-1100
(316) 440-1100
Mailing address
5366 N LYCEE ST, BEL AIRE, KS 67226-8701
(785) 458-2633
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-01021
KS
Other
Enumeration date
11/30/2016
Last updated
11/30/2016
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