Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 09570 | OR |
N | 225200000X | Physical Therapy Assistant | 60734974 | WA |
Y | 225200000X | Physical Therapy Assistant | PTA49220 | CA |
NPI | 1013488527 |
---|---|
Provider Name | Jennifer Victoria Tanner |
First Address | Bremerton, WA 98337-1113 |
Second Address | Bremerton, WA 98337-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2018 |
Last Update Date | 09/12/2018 |