Provider Demographics
NPI:1548154313
Name:LAFFERTY, TYRELL MICHEAL
Entity type:Individual
Prefix:
First Name:TYRELL
Middle Name:MICHEAL
Last Name:LAFFERTY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51109-1146
Mailing Address - Country:US
Mailing Address - Phone:712-454-9108
Mailing Address - Fax:
Practice Address - Street 1:1312 RIVER DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51109-1146
Practice Address - Country:US
Practice Address - Phone:712-454-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer