Provider Demographics
NPI:1013377266
Name:TEPEN, TANYA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:TEPEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 S BRENTWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1203
Mailing Address - Country:US
Mailing Address - Phone:314-644-1978
Mailing Address - Fax:314-433-3973
Practice Address - Street 1:693 DECKER LN
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6710
Practice Address - Country:US
Practice Address - Phone:314-656-7578
Practice Address - Fax:314-997-4532
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005644225100000X
IL070022017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist