Provider Demographics
NPI:1114536646
Name:TRIPP, TANNER (PT)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:TRIPP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WESTVIEW PARK PL
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3074
Mailing Address - Country:US
Mailing Address - Phone:406-393-2473
Mailing Address - Fax:406-393-2475
Practice Address - Street 1:100 WESTVIEW PARK PL
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3074
Practice Address - Country:US
Practice Address - Phone:406-393-2473
Practice Address - Fax:406-393-2475
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty