Provider Demographics
NPI:1235257874
Name:TAN-ATIENZA, KATHERYN (PT)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:TAN-ATIENZA
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 1:75 BROADWAY APT 2K
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1744
Mailing Address - Country:US
Mailing Address - Phone:610-710-1819
Mailing Address - Fax:
Practice Address - Street 1:401 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-2211
Practice Address - Country:US
Practice Address - Phone:570-385-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGEA7038740100OtherBLUE CROSS PPO
PA05598827TPAOtherAMERIHEALTH ADMINISTRATOR