Provider Demographics
NPI:1003112103
Name:REGISTRE, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:REGISTRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 GRIDLEY ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2606
Mailing Address - Country:US
Mailing Address - Phone:631-940-4051
Mailing Address - Fax:
Practice Address - Street 1:159 DEER LAKE DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3403
Practice Address - Country:US
Practice Address - Phone:631-703-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027684225100000X
NY027684-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist