Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1770 | MS |
NPI | 1063751063 |
---|---|
Provider Name | Mrs. Valarie Nicole Tanner |
First Address | Tuscaloosa, AL 35404-5015 |
Second Address | Tuscaloosa, AL 35404-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 11/02/2013 |