Provider Demographics
NPI:1205392214
Name:TANSECO, DENISE (PT)
Entity Type:Individual
Prefix:MR
First Name:DENISE
Middle Name:
Last Name:TANSECO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DIVEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2814
Mailing Address - Country:US
Mailing Address - Phone:862-703-1853
Mailing Address - Fax:
Practice Address - Street 1:40 DIVEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2814
Practice Address - Country:US
Practice Address - Phone:862-703-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00938100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT04721620012752OtherDRIVER'S LICENSE