Provider Demographics
NPI:1164656567
Name:KNAUFF, TANYA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:M
Last Name:KNAUFF
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 1:924 W CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1067
Mailing Address - Country:US
Mailing Address - Phone:815-844-4690
Mailing Address - Fax:815-844-4810
Practice Address - Street 1:924 W CUSTER AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1067
Practice Address - Country:US
Practice Address - Phone:877-348-8500
Practice Address - Fax:815-844-5411
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200599001Medicare PIN