Provider Demographics
NPI:1043572654
Name:JOSEPHS, TANYA (DPT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARY
Other - Last Name:GOUDIABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:101 E MARKET ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3981
Mailing Address - Country:US
Mailing Address - Phone:919-912-2030
Mailing Address - Fax:
Practice Address - Street 1:101 E MARKET ST STE 3B
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3981
Practice Address - Country:US
Practice Address - Phone:919-912-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00379-G225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist