Provider Demographics
NPI:1225087331
Name:TATGE, LAUREL LEE (PT)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:LEE
Last Name:TATGE
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 1:50 E DUVAL RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4153
Mailing Address - Country:US
Mailing Address - Phone:520-648-0270
Mailing Address - Fax:520-625-1003
Practice Address - Street 1:50 E DUVAL RD
Practice Address - Street 2:SUITE 10
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4153
Practice Address - Country:US
Practice Address - Phone:520-648-0270
Practice Address - Fax:520-625-1003
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501000760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN93670019Medicare PIN