Provider Demographics
NPI:1295189942
Name:TANGUAY, KATHERINE (MS ATC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 RIDGEMONT CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1253
Mailing Address - Country:US
Mailing Address - Phone:315-569-3391
Mailing Address - Fax:
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE G100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer