Provider Demographics
NPI:1083484927
Name:TANINIES, KAYLA ROSE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:TANINIES
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 1:41 REINING RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-3143
Mailing Address - Country:US
Mailing Address - Phone:570-352-8364
Mailing Address - Fax:
Practice Address - Street 1:1346 ROUTE 739
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-3423
Practice Address - Country:US
Practice Address - Phone:570-840-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE013434225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant