Provider Demographics
NPI:1164493227
Name:CROMWELL, TANA LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TANA
Middle Name:LEE
Last Name:CROMWELL
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 1:3782 E RIGGS ST
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3377
Mailing Address - Country:US
Mailing Address - Phone:406-227-1593
Mailing Address - Fax:
Practice Address - Street 1:2525 COLONIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4902
Practice Address - Country:US
Practice Address - Phone:406-449-4279
Practice Address - Fax:406-449-8043
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT841391220011OtherEBMS
MTMSF1128515OtherMT STATE FUND
MT0345049Medicaid
MT0157386OtherWAWC
MT000061936OtherBCBS
MT1164493227OtherMT HEALTHCARE
MT650020028OtherRR MEDICARE
MT000005960Medicare PIN
MT000005960Medicare ID - Type Unspecified