Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 26860 | CA |
NPI | 1225192453 |
---|---|
Provider Name | Mr. Todd Manning Tanner |
First Address | Vallejo, CA 94589-2441 |
Second Address | Vallejo, CA 94589-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 03/01/2022 |