Provider Demographics
NPI:1194852673
Name:TENNEY, HYRUM R (PT)
Entity Type:Individual
Prefix:
First Name:HYRUM
Middle Name:R
Last Name:TENNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:TENNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1680 W IRON SPRINGS RD
Mailing Address - Street 2:STE 104
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3313
Mailing Address - Country:US
Mailing Address - Phone:602-888-1426
Mailing Address - Fax:
Practice Address - Street 1:1680 W IRON SPRINGS RD
Practice Address - Street 2:STE 104
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3313
Practice Address - Country:US
Practice Address - Phone:602-888-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7612OtherSTATE LICENSE
AZAZ0461050OtherBLUE CROSS BLUE SHIELD